SAFETY AND SECURITY IN THE VA

HEARING
BEFORE THE

SUBCOMMITTEE OVERSIGHT AND INVESTIGATIONS

OF THE

COMMITTEE ON VETERANS' AFFAIRS

HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFl'H CONGRESS
FIRST SESSION

MAY 22,1997

Printed for the use of the Committee on Veterans' Affairs

Serial No. 105-10

U.S. GOVERNMENT PRINTING OFFICE

43-679 CC WASHINGTON: 1998

For sale by !he U.S. Government Printing Office

Superintendent of Documents, Congressional Sales Office, Washington, DC 20402
ISBN 0-16-055999-5
 COMMITTEE ON VETERANS' AFFAIRS
BOB STUMP, Arizona, Chairman
CHRISTOPHER H. SMITH, New Jersey LANE EVANS, Illinois
MICHAEL BILIRAKIS, Florida JOSEPH P. KENNEDY II, Masaachusetts
FLOYD SPENCE, South Carolina BOB FILNER, California
TERRY EVERETT, Alabama LUIS V. GUTIERREZ, Illinois
STEVE BUYER, Indiana JAMES E. CLYBURN, South Carolina
JACK QUINN, New York CORRINE BROWN, Florida
SPENCER BACHUS, Alabama MICHAEL F. DOYLE, Pennsylvania
CLIFF STEARNS, Florida FRANK MASCARA, Pennsylvania
DAN SCHAEFER, Colorado COLLIN C. PETERSON, Minnesota
JERRY MORAN, Kansas JULIA CARSON, Indiana
JOHN COOKSEY, Louisiana SILVESTRE REYES, Texas
ASA HUTCHINSON, Arkansas VIC SNYDER, Arkansas
J.D. HAYWORTH, Arizona CIRO D. RODRIGUEZ, Texss
HELEN CHENOWETH, Idaho
RAY LAHOOD, ILLINOIS
CARL D . COMMENATOR, Chief Coun.sel and Staff Director

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

TERRY EVERETT, Alabama, Chairman
BOB STUMP, Arizona JAMES E. CLYBURN, South Carolina
FLOYD SPENCE, South Carolina VIC SNYDER, Arkansas
STEVE BUYER, Indiana FRANK MASCARA, Pennsylvania

(II)
 CONTENTS
Pag.

OPENING STATEMENTS
Chairman Everett .................................................................................................... 1
Hon. James E. Clyburn ........................................................................................... 2
Prepared statement of Congressman Clyburn .............. .......... ....................... 43
Hon. Lane Evans, ranking democratic member, Full Committee on Veterans'
Affairs .................................................................................................................... 2
Prepared statement of Congressman Evans .................................................. 43
Hon. Vic Snyder .............................................. ......................................................... 16
WITNESSES
Baffa, John H., Deputy Assistant Secretary for Security and Law Enforce-
ment, Department of Veterans Affairs .............................................................. . 3
Littl~:-el:::t s~~F:~~tt::: ~:~ p~i~iv~~;~Aff;;i~~M~di~~i'c~~~;;
46
accompanied by Sandra Choate, Assistant General Counsel, American Fed-
eration of Government Employees ..................................................................... . 38
Prepared statement of Mr. Little, with attachments .................................. .. 65
Miller, Richard P., Director, G.V. "Sonny" Montgomery Veterans Affairs Medi-
cal Center, Veterans Health Administration, Department of Veterans M-
fairs; accompanied by John E. Ogden, Director, Pharmacy Service, Veterans
Health Administration, Department of Veterans Affairs; accompanied by
Kenneth Faulstich, Engineering Management and Field Support Office,
Veterans Health Administration, Department of Veterans Affairs ................ . 20
Prepared statement of Mr. Miller .................................................................. . 239
Rinkevich, Charles F., Director, Federal Law Enforcement Training Center,
Dejlartment of Treasury ..................................................................................... . 30
Prepared statement of Mr. Rinkevich ............................................................ . 54
Vit~kaC8, Joh~, ~istant .Director! National Veterans Affairs and Rehabilita-
tIon CommISSIon, Amencan Le!p~n .................................................................... 35
Prepared statement of Mr. VltikaCS .................................. ,'............................ . 57
Wolfinger, Joseph, Assistant Director of the Training Division, Federal Bu-
reau of Investigation .......................................................................................... .. 28
Prepared statement of Mr. Wolfinger ............................................................ . 44
Zicafoose, Barbara Frango, MSN, RNCS, ANP, Legislative Co-Chair, Nurses
Organization of Veterans Affairs ....................................................................... . 36
Prepared statement of Ms. Zicafoose ............................................................ .. 61
MATERIAL SUBMITTED FOR THE RECORD
Letter from Fredrick Roll re work place violence and health-care security
S:~':ne:;,.~:lJ;ti~!:l~~~ii~~~f~~~~~~tE-;;;pi~y~~~::::::::::::::::::::::::::::
92
90
Written committee questions and their responses:
Congressman Evans to Department of Veterans Affairs ............................ .. 244
Congressman Snyder to Department of Treasury ........................................ . 317

(In)
 SAFETY AND SECURITY IN THE VA

THURSDAY, MAY 22, 1997

HOUSE OF REPRESENTATIVES,
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS,
COMMITTEE ON VETERANS' AFFAIRS,
Washington, DC.
The subcommittee met, pursuant to call, at 9:30 a.m. in room
334, -Cannon House Office BuilQing, Hon. Terry Everett (chairman
of the subcommittee) presiding.
Present: Representatives Everett, Clyburn, Snyder, Evans.
OPENING STATEMENT OF CHAIRMAN EVERETT
Mr. EVERETT. The hearing will come to order. Please cease all
conversations. Good morning. Today's hearing by the Subcommittee
on Oversight and Investigations will examine the safety and secu-
rity of our veterans and our valued 240,000-plus VA employees.
I've become increasingly concerned about personal safety issues at
the VA after hearing about the tragic murder of Dr. Ralph Carter
at the G.V. "Sonny" Montgomery Veterans' Affairs Medical Center
in Jackson, FL, this past February. I understand that this is the
second violent assault at this facility in less than 2 years. Other
incidents at VA facilities have also raised complex questions about
the safety of veteran and VA staff alike.
The VA's response. has been to develop a pilot frogram to arm
its hospital law-enforcement officers. The arming 0 VA police must
be done at a very deliberate pace with stringent safeguards. Before
going full-scale we must be confident that this is the right way to
improve hospital security. We want to be reasonably assured that
fire fights won't erupt in hospital lobbies, wards and parking lots.
Standards for the VA should be no less than that for any other
armed federal law-enforcement agency.
We will also examine the security of controlled drugs in VA hos-
pitals, VA pharmacy operations which cost more than $1 billion
this year. Due to the high value of the VA drug inventories with
respect to theft, we'll examine how the VA has addressed account-
ability and security problems which have previously been identified
by VA's I.G. Additionally, the VA still maintains 30 hospital fire
stations with an annual operating budget of over $16.3 million and
staffed with 357 fire fighters. Today we will review fire safety is-
sues critical to our VA patients, employees and our fire fighters. I
think we have a full plate for discussion today. I look forward to
hearing testimony, and I would ask that all people testifying please
condense your statements to 5 minutes. And now at this time I'd
like to recognize our ranking member, Mr. Clyburn.
(1)
 2
OPENING STATEMENT OF HON. JAMES E. CLYBURN
Mr. CLYBURN. Thank you, Mr. Chairman. As ranking Democratic
member of this Committee, I'm pleased to join with you in holding
this important hearing. I know that safety and security of our VA
hospitals are of utmost importance to the VA and to members of
this Committee. In my view, we would not be accomplishing our
mission of providing the highest possible health-care service to our
veterans if we are unable to protect the safety and integrity of our
VA hospitals. I am greatly interested in hearing testimony from the
VA on its pilot project to arm VA police officers at certain VA
hospitals.
I'm aware that the tragic shooting of a doctor in Jackson, MS
earlier this year has caused renewed concern over the adequacy of
the safety and security of our VA hospitals. I must say, however,
that I believe the VA ought to be taking a measured approach
when it comes to making anr. final decision to arm its police offi-
cers. Very few private hospltals even in some of the dangerous
crime-ridden areas of our country allow the officers who ~ard
their facilities to carry guns. I believe there is a reason for this. As
the written testimony of the Nurse's Association sug~ests, hospitals
are for making sick people healthy; guns are for killing people. The
VA should be extremely cautious in its approach to this issue.
There should be an extensive, well-thought out hospital-by-hospital
analysis of the feasibility and propriety of arming VA officers be-
fore jumping into such a course of action.
To my mind at least, it is just as easy to imagine a situation
where a VA officer accidentally kills or seriously injures somebody
during the course of his duties as it is to imaiPne a situation where
the officer's gun keeps a killing or serious injury from occurring. I
welcome the opportunity to hear testimony on this extremely sen-
sitive issue, as well as the chance to get an update on the status
of VA fire departments and the VA's accountability of controlled
substances. Thank you again, Terry, for working with us to put to-
gether such a timely and important hearing.
[The prepared statement of Congressman Clyburn appears on p.
43.]
Mr. EvERETT. Thank you, Jim, and this Committee is honored to
have the ranking member of the full Committee as a member of
this Committee, and at this point I'd like to ask my ranking full
Committee Chairman-full Committee member-ranking member
if he has any comment.
OPENING STATEMENT OF HON. LANE EVANS, RANKING DEMO-
CRATIC MEMBER, FULL COMMITTEE ON VETERANS'
AFFAIRS
Mr. EVANS. Thank you, Mr. Chairman. I think this is a very im-
portant hearing with the VA right in the middle of its pilot pro-
gram to arm VA police officers at selected cities. There's no more
appropriate time than now to conduct diligent oversight of this pro-
gram, and I of course share the concern about the recent efforts out
at the Jackson, MS facility, and I'm also deeply troubled by the
deaths of four VA police officers in the last 5 years. Safety and se-
curity of patients, law-enforcement personnel and the doctors and
staff at our facilities has got to be an utmost priority and we
 3
should closely consider the means by which we can best accomplish
this mission. I am pleased that John Baffa is testifying before us
again. I think he has brought a new level of training and sophis-
tication and effort on the part of the VA and I look forward to the
testimony. Unfortunately, I will have to be attending the quadren-
nial review of the armed forces today with the Joint Chiefs of Staff,
so I won't be able to stay for the hearing, Mr. Chairman, but I just
wanted to thank you for your diligence and hard work.
[The prepared statement of Congressman Evans appears on p.
43.]
Mr. EVERETT. Thank you, Lane. I'd like to welcome all the wit-
nesses testifying today. At least one of our witnesses has traveled
some distance to testify and I want to thank all of you in advance
for ,being here. I would ask again that you limit your oral testimony
to 5 minutes. Your complete written testimony will be made part
of the official hearing record. We will ask members to hold ques-
tions until the entire panel has testified. I now recognize Mr. John
Baffa, Deputy Assistant Secretary for Security and Law Enforce-
ment and ask him to introduce the members of his panel before we
o any further. Also, at the end of Mr. Baffa's 5-mmute testimony
f would ask-be given an additional 5 minutes for a brief dem-
onstration for a safety feature on this gun holster. Mr. Baffa as-
sured me and assured the staff that the weapon is appropriately
disabled and is not loaded. Mr. Baffa.
STATEMENT OF JOHN H. BAFFA. DEPUTY ASSISTANT SEC-
RETARY FOR SECURITY AND LAW ENFORCEMENT, DEPART-
MENT OF .VETERANS AFFAIRS; STATEMENT OF RICHARD P.
MILLER, DIRECTOR, G.V. "SONNY" MONTGOMERY VETERANS
AFFAIRS MEDICAL CENTER, VETERANS HEALTH ADMINIS-
TRATION, DEPARTMENT OF VETERANS AFFAIRS; ACCOM-
PANIED BY JOHN E. OGDEN, DIRECTOR, PHARMACY SERV-
ICE, VETERANS HEALTH ADMINISTRATION, DEPARTMENT
OF VETERANS AFFAIRS; ACCOMPANIED BY KENNETH
FAULSTICH, ENGINEERING MANAGEMENT ,AND FIELD SUP-
PORT OFFICE, VETERANS HEALTH ADMINISTRATION, DE-
PARTMENT OF VETERANS AFFAIRS
STATEMENT OF JOHN BAFFA
Mr. BAFFA. Thank you. Thank you, Mr. Chairman, members of
the subcommittee. I am pleased to be here today to discuss issues
related to safety and security of VA facilities. With me today I have
Mr. Richard Miller, Director of the VA Medical Center, in Jackson,
MS; Mr. John Ogden, Director of Pharmacy Service in VHA; Mr.
Kenneth Faulstich, fire protection en~eer in VHA; and Mr. Walt
Hall, Assistant General Counsel. VA s official statement provides
details about security in law enforcement, the strides we have
made in the area of securing in our pharmacies against theft, VA's
fire protection program and the recent desecration of the National
Memorial Cemetery of the Pacific.
Thank you for the opportunity to speak to you today. I think it
is fitting that this hearin~ is being held just a few days after the
National Police Week actIvities in .which the President, Congress
and the nation paid tribute to the police officers killed in the line
 4
of duty during 1996. This year as in years past my department has
lost one of its own. Officer Hoerst Woods of Albuquerque was wan-
tonly and without provocation gunned down in the VA parking lot
in Albuquerque, NM. Officer Woods was unarmed. Seven years ago
when I took this position I received beneficial insight, comments
and advice from some members of this Committee and/or its staff.
I feel I've answered every question, addressed every issue, calmed
many fears and made many improvements. Recently, VNs maga-
zine, "The Vanguard," did its feature article on the VA police. It
was entitled, "VA Police: the Force is With Us." I think that one
title emphasizes what we are all about and how we feel about our
veterans and want our veterans to feel about us. In addition, the
first sentence stated, and I quote, "For the VA, the nineties have
been a decade of reinvention. For the VA police, make that a trans-
formation." We have increased the VA basic police training course
to 160 hours. We have developed specialized training for chiefs and
detectives. We have implemented a regimented monthly in-service
trainin~ program for all officers at their stations. We have a police
chiefs mtem. We have use of a K-9 program for missing patient
searches, security and the illegal drug interdiction. We have moved
the physical location of the police officer at most hospitals to make
them more visible to our customers. We have increased foot patrols
and at some facilities instituted bicycle patrols to be more visible,
closer and accessible to our customers.
Recently we have implemented a pilot program to arm our VA
police at selected locations. In short, we have made significant
strides, but we must go forward if we are to continue to provide
a safe environment for our veterans and our employees. I spent 26
years, my entire adult working life, in federal law enforcement in
protection of citizens of this country. The last 7 here in the VA
have been challengin~, sometimes frustrating but overall very re-
warding. With the gwdance and help of the Secretary we have ac-
complished much, but as I stated and you have articulated, we
have much to do. I can assure you that my office is driven by the
goal of providing a safe and secure environment for our veterans,
their guests and the employees of the Department of Veterans
Affairs.
With regard to pharmacy issues, since 1992 the House of Veter-
ans' Affairs Committee hearing on controls of addictive drugs and
drug diversion, the VA has made significant .progress. Working
with the Office of the Inspector General, the General Accounting
Office, and the Office of Security and Law Enforcement, the Veter-
ans Health Administration has instituted regulations over the ac-
countability of controlled substances that are more strict than any
State or any other health-care system's requirements. My col-
league, Mr. Ogden, is prepared to address these issues.
VA's fire safety program is another program that ensures the
safety of our VA employees and the veterans. At the vast majority
of the Department's medical centers the fighting services are pro-
vided by local community fire departments. In the event that local
fire fighting services do not meet VA's minimum level of require-
ments, VA operates in-house fire departments. There are currently
30 .in-house fire departments, each which is staffed by approxi-
mately 15 employees who are fire fighters. Mr. Ken Faulstich is
 5 '
here to provide details about the fire protection program. Addition-
ally, there are two separate recent issues or events that have
caused concern for VA employees, patients and visitors ,to the VA.
One was the shooting at Jackson, Mississippi VMAC that resulted
in the death of a patient .and an employee and the desecration by
vandals of the National Memorial Cemetery of the 'Pacific.
Mr. Chairman, my colleagues and I will be happy to answer any
questions, but first it is my understanding you'd like to see a dem-
onstration of the firearm and the safety factors, and I would like
to have Mr. Bill Harper come 11P and show that to you.
[The prepared statement of Mr. Baffa appears on p. 46.]
Mr. EVERETl'. We'd be happy to honor your request to show that
to us.
Mr. BAFFA. Bill? Sir, I'm going to show you that this gun is un-
loaded. You can see that it is unloaded. It's also been checked by
the U.S. Capitol Police. There is no bullet in the chamber, and
there's no bullet in the magazine. The question deals with the safe-
ty of this weapon. This weapon is double-action only. Actually, it
works like a magazine-fed revolver. The-hammer never stays
cocked, always traveling forward with the slide coming to rest in
the double-action position. Each pull of the trigger draws the ham-
mer back and releases to fire the pistol. This feature reduces the
chance that the pistol will be accidentally fired. Number two, the
magazine will not fire-excuse me, the weapon will not fire if the
magazine is released. The pistol will not fire unless the magazine
is fully seated even if there is a round in the chamber. This feature
allows the officer to make the pistol nonoperational at any time by
releasing the magazine with the touch of a button. The officer then
may place the magazine in the holster pocket, making the weapon
fully safe. It will only fire with a VA-issued magazine. The pistol
and magazine have been specially designed by Beretta at no extra
cost so they will only fire with the magazine issued to the officer.
The pistol will not fire using the standard Beretta magazine. The
weapon will not accidentally fire. The pistol has a firing pin block
on the top of the slide which actually blocks the firing pin until the
trigger is pulled. Even if the pistol is dropped, it will not fire. It
also has a loaded chamber indicator. When there is a round in the
chamber, the extractor claw protrudes, exposing a red slide. An .of-
ficer can thereby easily determine visually without aiming the
weapon-a weapon or a round in the chamber.
Last but not least, we have a security holster, and it is consid-
ered a level three security holster. This holster is equip~d with in-
ternal safety locking devices that drastically reduce, If not elimi-
nate, the possibility of anyone other than the officer from drawing
the weapon from the holster. Your staff member couldn't do it a
couple days ago. We'd like to have this man who's never seen it try
to pull that weapon out of the holster if you could. And I also would
like to try it, and you can see how quickly the officer was able to
get the weapon out. That right there plus the intense training both
on the range and lectures make me believe this a totally safe weap-
on to be used in the hospital facility above and beyond what most
police departments use nationwide. But anything else you'd like see
with the weapon, sir? Are there any other aspects of the weapon
you'd like to---
 6
, Mr. EVERETT. I assume you were holding on down 'the holster
just to keep it from coming up-you were holding the belt. I see.
Mr. BAFFA. Sir, he's the thinnest man I've got.
Mr. EVERETT. Well, we do congratulate you on this safety fea-
ture. I assumed it was something that VA came up with, or it may
have existed already , ,
Mr. BAFFA. .The holster existed already, sir. We have spent
countless days and weeks studying and coming up with the best
weapon as far as safety aspects go and the accompanying holster,
to make sure that-nothing is totally fail safe, I wish I could give
you that assurance, but we believe we have done the best possible
to assure that nothing that concerns you would happen with this
particular weapon.
Mr. EVERETT. Thank you very much.
Mr. BAFFA. Yes, sir. Sir, we will answer any questions you might
have.
Mr. EVERETT. Do any other members of your staff wish to make
any statements?
Mr. BAFFA. I don't believe so, sir. We're ready to answer any
questions that you the Chair or your colleagues have.
Mr. EVERETT. Well, first of all, I want to thank you for coming
up and appearing here today. As I said, I congratulate you on those
safety features. They are impressive. However, I will say that in
the beginning that I have grave concerns about the idea of arming
the security forces in VA hospitals. And we have some I think very
straightforward and candid questions. We would appreciate an-
swers likewise.
Mr. BAFFA. Yes, sir.
Mr. EVERETT. While myself and Jim, the ranking member of this
Committee, are the only two here, I can assure you that that does
not indicate the interest in this subject. This is a small Committee,
but it is a Committee made up of Floyd Spence who is the Chair-
man of the National Security Committee, Bob Stump, the full VA
Chairman, and as you heard just a moment ago, ranking member
of the full Veterans' Committee who has gone for the QRD hearing
which is going on along with this hearing, and of course that's
where Chairman Stump and Chairman Spence are also. Let me
begin by saying, if you would, explain to me why VA believes it's
necessary at this time to have a pilot program to arm VA hospital
police.
Mr. BAFFA. Mr. Chairman, we do not look at the weapon as a
cure-all. We look at it as an additional tool. If you remember from
my opening statement, we've done a lot of other things. We have
instituted a K-9.program.
Mr. EVERETT. Excuse me just a moment.
Mr. BAFFA. Yes, sir.
Mr. EVERETT. I'm going to dispense with the 5-minute rule. Only
myself and our ranking member are here and I'm goin~ to allow
each of us as much time as we would like to explore this subject.
Mr. BAFFA. Yes, sir. As I was saying, I realize that the issuing
of firearms is a very sensitive issue. It is with me and with the Sec-
retary and Dr. Kaiser. I look at the firearm as an additional tool
to help the police officer accomplish the goal of providing safety
and security at a VA hospital. As I indicated, we have K-9 pro-
 7
grams. We instituted a program a couple of years ago which was
vigorous patrol and getting out into the community, and if you'll
note by reading the papers, the city of Washin~n and the city of
New York have gone to the same theory, that if you get out there
and meet with the people and you prevent crime, you don't respond
to it. And our philosophy is you stop crime before it begins by not
letting people who don't belong into the hospital into the hospital.
I'd like to give you an illustration of how I think the weapon
helps, and there's three things with the weapon, and it's not shoot-
ing somebody. That's the final, ultimate thing that nobody wants
it to. The VA police officers don't want to do it, I don't want it. No-
body in this room wants this to happen. But again, I like to use
examples, and again, these are three examples, if they don't satisfy
you, I will go on. In Richmond, VA, at our hospital, VA police
around midnight approached a vehicle that was in the parking lot.
These people had no reason being there. They were not veterans.
They just consummated a drug deal and they were sitting there
counting their money. They both had long criminal histories. The
VA police approached them, asked them what they were doing and
they immediately surrendered. After they were arrested, the one
felon who was more than a three-time loser said, "You know, if I
had known these people were not armed I would have killed them
because I have nothing to lose." So, the fact that an individual is
armed is a deterrent, just that he's carrying the weapon.
Number two, and I'd like to give you a second illustration, I men-
tioned to )Tou about Officer Hoerst Woods who was killed in Albu-
querque, NM. After he was killed the assailant took the keys off
of his belt and tried to steal the car and could not get the car. Peo-
ple heard gun shots go off and he started flailing his hands and no
one could get to the injured officer because he was threatening to
shoot them. The Air Police, and this is a joint facility, who are
armed responded, drew their weapons, told them to surrender, and
he finally did surrender. Again, a case where the weapon was used
but it was not fired. The third case that I would like to use is Lake
City, FL, where our police officers approached an individual who I
believe the nursing staff had complamed about was harassing them
outside. He went up to the car. As he approached the car the man
pulled a weapon out. The officer had nothing to do but turn and
run and was shot in the back. After the officer was shot, who was
the line of defense to gaining entry into the hospital, the individual
then got into the hospital and shot the hospital up. So, I think
those .are three different areas where the use of a firearm probably
would have been used, in the third case would have prevented
those incidents from happening.
Mr. EVERETr. The question was, why is it necessary at this time
to have a pilot program? I gather from that answer that you're say-
ing-
Mr. BAFFA. Times are changing, sir. We're having more violent
crime. .
Mr. EVERETr. More violent crime?
Mr. BAFFA. More violent crime at our facilities. I've given you
three examples of what's occurring on our facilities.
Mr. EVERETr. Let me ask you about that. Perhaps the figures
I've seen are incorrect, but the figures I've seen of total crime in-
 8
eluding everything, violent crime, has dropped really about 20,000
instances from 1990 to 1994. Have I been given some wrong infor-
mation? I think there were about 60,000 instances reported in
1990. Has the staff got that stuff somewhere? In 1994, about
40,000 instances.
Mr. BAFFA. I think those were disturbances. I don't think the
title was violent incidents. I may stand corrected.
Mr. EVERETT. My information is it's all-inclusive.
Mr. BAFFA. All-inclusive. That's correct, sir. And again, that goes
to the whole package that we're talking about. The more vigorous
patrol, the use of the K-9 program. We're getting too many people
injured and killed and I think that the thing is, we want to serve
our veterans and give them good health care, but we want to make
sure our veterans and our staff feel safe and are willing to come
to work to take care of that issue.
Mr. EVERETT. I'm sorry, the figures are 1990 to 1993, and this
includes disturbances including bomb threats and threats to em-
ployees, manslaughter, rape, assaults, weapons possession, illegal
drug cases, robberies, liquor possession. And in addition to that,
further information that I had not seen until now shows that it's
gone down from 1990 to 1996 from roughly 59,995 to 25,983. So,
it's more than half the amount of violent crime that we've seen in
the past.
Mr. BAFFA. Sir, I don't know if you have the same one that I
have, and I'm checking it right now. If you look at 1994, it says,
"Disturbances including bomb threats and threats to employees,"
that has gone down. That is correct. That has gone down.
Mr. EVERETT. My staff tells me this information that I'm looking
at and reading from was provided by the VA.
Mr. BAFFA. Right. Well, I'm not denying that. What I'm saying
to you though, the one that you looked at, the major decreases in
disturbances, and that's an all-fitting category. If you look at as-
saults, I'd like you to look at assaults, you will see that the as-
saults have remained pretty much consistent. In 1994 I have 1,660;
in 1995 I have 1,551; and in 1996 I have 1,624. If you look at the
liquor possessions, you look at the illegal drug cases. The crimes
of violence--
Mr. EVERETT. Let me stop you there because our figures just
aren't jibing. I show in 1990 that you had 5,217 assaults.
Mr. BAFFA. Okay, sir, 5,217, that's correct. But what I'm saying
to you, last year when we implemented these new programs, that's
what has caused the decrease. And do you have 1994, 1995 and
1996?
'Mr. EVERETT. Yes, I do. Let me read my figures and the you tell
me where I'm wrong. .
Mr. BAFFA. Okay, sir.
Mr. EVERETT. In 1990 assaults/all, 5,217; 1991, 4,624; 1992,
4,181; 1993, 3,738; 1994, 3,399; 1995, 3,315; 1996, 3,205.
Mr. BAFFA. Yes, sir. I understand that, but I think I had told
your Committee before, and if I hadn't I apologize, but some of the
information contained on this and the .preceding pages are of ques-
tionable accuracy. In 1989 the VA Office of Inspector General is-
sued a report highly critical of the accuracy of the information con-
tained in the VA's crime reporting system. During inspections con-
 9
ducted by the Office of Security and Law Enforcement since 1990,
it was found that many facilities were overstating and some were
understating crime statistics which were recorded manually.
Mr. EVERETT. So, what you're telling me is that the VA's system
of reporting these crimes is not accurate?
Mr. BAFFA. At that time it was not. It is accurate today.
Mr. EVERETT. That report was in 1989. Did the VA wait all these
years to correct it?
Mr. :aAFFA. No, sir, it did not. As soon as I came on and found
that there was a deficiency, we went and got--
Mr. EVERETT. You've been there 7 years?
Mr. BAFFA. Pardon me? Seven years.
Mr. EVERETT. I'm sorry. You said you've been there--
Mr. BAFFA. Yes, sir, and I obtained funding and we do have a
computer package now that is accurate.
Mr. EVERETT. Let's move a little past that because I want to give
Mr. Clyburn some time too. Let me ask you a couple things on this.
Will VA hospital police be subject to drug screenings such as
urinalysis?
Mr. BAFFA. Sir, all VA police that are hired now are subject to
random drug testing.
Mr. EVERETT. Urinalysis?
Mr. BAFFA. That's correct, sir.
Mr. EVERETT. How about previously-hired security officers?
Mr. BAFFA. It is my understanding that at some time during the
summer the VA drug testing program which includes police officers
will be implemented and they will be subject to drug testing. If
during the course of business we have reason to believe a police of-
ficer is acting suspiciously, we can mandate that he be drug tested.
Mr. EVERETT. Let me get into this, and what we may do, Jim,
with your permission, we may have two rounds here because I
want to ask another question and I want to turn it over to you.
Why does VA seem to be about the only federal department or
agency that does its own police training? Everybody else that we
can discover does it at the FBI or the Federal Law-Enforcement
Training Center. Why can't the VA train there also?
Mr. BAFFA. Yes, sir, that is a very good question and I'd like to
expand upon that. I'm not sure that Justice does any training of
federal police officers, but I could stand corrected on that. The VA
police have duties beyond .traditionallaw enforcement. They're also
part of the patient care health team. I'm going to go on record as
saying that I think what FLETC does, which is Glynco, does an
outstanding job in training their police officers. They have an eight-
point program in training and the sum of their training equals the
parts of their training, and that training is broken down into many
different facets one of which is firearms training.
Up until this date we have not had firearms training as a stand-
ard procedure. It is my feeling that when you expose our VA police,
and you have to understand that at Glynco in these training class-
es which I believe are made up of 40 students per class in basic
training or thereabouts, that only a small percentage of them
would be VA police, four, five, six, maybe as little as one or two.
They would go in there with the expectations of seeing other police
officers trained in the use of weapons, and again, that's one part
 10
of the big equation and the expectation is when they return back
to their station would not be there because we do not arm our
police.
In addition, Title 38, Chapter 9, states that training, referring to
police officers, will have emphasis on situations dealing with pa-
tients, patient health care. We're a unique team. Again, I'd like to
give you an example of what I'm referring to instead of just words.
Recently I took the Chief of Staff up to the Bronx to witness the
pilot program and what we were doing. A gentleman came through
the magnetometer carrying a knife, highly intoxicated, large man.
Caused a lot of programs. If we can have the police officers trained
in patient care, under most circumstances he probably would have
been arrested. But the fact is, he is there at that hospital seeking
treatment for what he was manifesting. As soon as he was sub-
dued, and I don't mean physically, I mean just talked about giving
his weapon away, he was put in a wheelchair and taken to the
emergency room where he got treatment. They would not teach
that at FLETC. You know, some would argue that-and it's not an
argument. Again, I take that word back. Some would say, well,
why don't you do like other law-enforcement agencies do, after the
initial 8-week course then send them to the VA and train them for
3 weeks? I would do that and will entertain doing that if in fact
some barriers are taken down, one being which the VA decides to
arm all of its police officers because then the training would be con-
gruent and conducive to having a second phase of training.
Mr. EVERETT. Let me just close this round by saying that I don't
know if you're familiar with the term "Q Courses," which the mili-
tary uses that very same option. They do primary training in a
number of fields, helicopter training, fixed-wing training, etc., etc.,
and then they send people on to specialized training, and they've
found that quite cost-effective. At this point let me tum it over to
my friend the ranking member, Mr. Clyburn.
Mr. CLYBURN. Thank you very much, Mr. Chairman. Let me
begin, Mr. Chairman, by stating that in preparation for this hear-
ing this morning the subcommittee staff contacted the American
Hospital Association to try to understand the degree to which pri-
vate-sector hospitals arm its law-enforcement and security person-
nel and the steps taken by private hospitals to decide whether it's
necessary to arm its officers. In this regard, the AHA suggested we
contact Mr. Fredrick Roll, a member of the American Society of
Health-Care Engineering who has extensive expertise in the field.
Scheduling conflicts precluded Mr. Roll from testifying in person
before the subcommittee this morning. We are especially grateful
to Mr. Roll, however, for agreeing to provide a letter and supple-
mental materials relating to work place violence and health-care
security issues to be included in the record for today's hearing. Mr.
Chairman, I move that Mr. Roll's correspondence and supplemental
materials be included in the record of today's hearing.
Mr. EVERETT. Without objection, so ordered.
(See p. 92.)
Mr. CLYBURN. Thank you, Mr. Chairman. Mr. Baffa, the main
thrust of Mr. Roll's concerns with arming law-enforcement person-
nel at VA facilities appears to be a belief that any decision to arm
VA hospital officers should be based on a thorough case-by-case
 11
needs-based analysis of the individual VA facilities. In Mr. Roll's
view, and I might add, in my view as well, a blanket plan to arm
officers at each VA hospital would be ill-advised . .Do you share Mr.
Roll's concerns in this regard?
Mr. BAFFA. Sir, I'm not going to comment on Mr. Roll's view
point because I haven't seen anything he has to say, but I will com-
ment on what your view point is, and I agree with you 100 percent.
We are not out to mass arm everybody nationwide in the VA police.
One of the reasons we developed a pilot program was to take five
hospitals, five geographical areas, that had bigh crime rates and
test the system out. It's an ongoing testing system. No decision has
been made to blanketly arm all VA police nationwide. We're not
ready for that, and I will be the first one to tell you we're not ready
for that. That has never been my intention, that has never been
the Secre?nis intention. Again, it's called a pilot program because
we're explonng possibilities. We've done the same thing with the
K-9 program. Not all VA hospitals have dogs, and it's a voluntary
program.
Each hospital that's participating in the pilot program volun-
teered to participate in the program because they just felt that they
had needs and issues that only an armed police officer could han-
dle. I have one of those directors right here who maybe would like
to expand upon it if you'd like, sir. But to answer your question,
I agree with you.
Mr. CLYBURN. Absolutely. Let me say this is the director of the
Jackson facility.
Mr. BAFFA. That's correct. Yes, sir.
Mr . CLYBURN. You came to this conclusion by using a regional
approach wherein there were-I'm assuming that you're saying
that the areas around the medical centers are areas of high crime
rates is what you're saying? Or did you mean high crime rates in
the region?
Mr. BAFFA. Well, on all accounts that's correct, sir. When we
started thinking about arming our police officers, I wanted to
choose five hospitals geographically located across the country by
region. I wanted to have five hospitals that I knew that the police
force was where I thought it should be before we would commence
or begin a_pilot program. We also looked at the crime rate at those
facilities. We don't determine the crime rate. The Federal Bureau
of Investigation does that. What they do is, they have a statistical,
and I don't have the formula with me, sir, that shows how many
crimes are committed per 100,000 population and it comes with a
figure.
I personally chose New York City as kind of like the base line,
the border line, and their crime figure came as 7. All five facilities
that we chose had a crime rate higher than the 7 as I articulated
to you just a few seconds ago.
Mr. CLYBURN. Did all these places have incidents? I know about
the incident at Jackson. I think you mentioned one that I'm famil-
iar with in 1992 I saw in something here at the Columbia, SC
facility.
Mr. BAFFA. That's correct. Yes, that was looked at also. They had
incidents, and we have to rely on the local staff, i.e., the directors
and what-have-you. I can come into any facility and make a rec-
 12
ommendation, but you have to know the pulse of the facility and
that's why we work with the local community as well as the police
forces involved.
Mr. CLYBURN. I guess that's what I'm getting to here. You men-
tioned you selected facilities where the police forces were ready.
What do you mean ready?
Mr. BAFFA. Well, you issued your concern. That was just one of
the criteria. The criteria was that the local hospital director and
staff wanted to participate, number one. We do a cyclical inspec-
tion. Every 3 to 4 years we check the hospitals and how they're op-
erating their police force. Obviously, we have 169 hospitals, some
are better than others. Of the people that volunteered, I picked
what in my view point was the best facilities and best police officer
management program in the nation because I want like you to suc-
ceed and I did not want to jump in and just randomly pick some
people and arm them. I figure if we can make it work with the best
of people, then we can look and give it to the Secretary to look
beyond.
Mr. CLYBURN. I guess what I'm trying to get to here, if you're
using as part of the criteria crime rates, incidents, a well-managed
hospital, I guess my question is, what methods of evaluations did
you use to determine the readiness levels at each of these facilities?
Mr. BAFFA. We do a series of program reviews. I send my people
who are not affiliated with the hospital out to that hospital to re-
view how the police are operating both administratively and tech-
nically. And that deals with everything, the proper training, they
are doing their proper training they're required to do, they are ro-
tating their shifts, everyone is getting the opportunity to perform
the same duties on a 24-hour-a-day, per week basis, 24 hours a
day, i.e., we change shifts every 3 or 4 months, we look at manage-
ment's philosophy about the police, we talk to the local police com-
munity. After we have done that and it meets the first check point,
makes the first cut, we then do physicals on all the police officers,
we do psychological testing of all the police offices. We come back
in and we give them a boiler plate standard operating procedure.
We talk to the unions, we talk to the staff, and we talk to every-
body, the veterans, the service organizations, everybody that's
going to be involved. At that point and that point alone do I then
give the blessing that that would be one of the pilot sites, and that
all happens before we begin starting the training of our police
officers.
Mr. CLYBURN. So, that was in preparation for this, but this is not
standard operating procedure?
Mr. BAFFA. The cyclical visits to see if the hospitals are working
is done every 3 to 4 years. In addition to that we do the other
things. You're talking about the arming of the police officers.
Correct?
Mr. CLYBURN. What I'm trying to determine is in your initial de-
termination here you indicated that one of the criteria right at the
top of your list was the readiness of the police officers.
Mr. BAFFA. Of the police officers.
Mr. CLYBURN. And I'm trying to determine how you got to that
conclusion that this group is ready and that group is unready.
 13
Mr. BAFFA. By all of the above, sir. By all of the above. I do that
at each facility.
Mr. CLYBURN. Yes, and I ask is this standard operating proce-
dure or is this something you did in preparation for being here this
morning in arming your police officers? Is this something that you
do? Now, you say you do it every 3 or 4 years, and all I'm saying
to you, sir, is it seems to me, and I'm sorry, I'm one of the few guys
who came to this Congress outside of the legislative process. I came
here from management.
Mr. BAFFA. Yes, sir. Right.
Mr. CLYBURN. And so when it comes to administration and man-
agement you're going to find me a little bit different from a lot of
people who are in elected office. And so what I'm trying to do is
determine whether or not you got to this point this morning
through standard operating procedure or whether or not you decide
that this is where I want to get, let me go out and find some places
that will get me there.
Mr. BAFFA. It is standard operating procedure for us to do cycli-
cal inspections of the hospitals to see if they are operating in a sat-
isfactory manner. Now, there's different levels of satisfactory. It is
standard operating procedure for a police officer to go through a
physical on an annual basis. It's standard operating procedure to
do psychological testing on whether an individual could be a police
officer on an annual basis. What I did to implement the pilot pro-
gram is go above that and do all the things that I previously articu-
lated to you to assure in my own mind that these police officers at
this facility were ready to be armed which is a question that a lot
of people-how do you know these police officers are qualified to be
armed. Based on all the things I just articulated which is above
and beyond what we do is how I made that determination. Yes, sir.
Mr. CLYBURN. How was the determination made to use in the fu-
ture, whether it's near future or I don't know, but I understand
that one of the facilities selected for the future is Hampton, VA.
Mr. BAFFA. That's correct. I did the same thing. I knew from pre-
vious experience and previous inspections as I referred to you that
that police department was operating in a top-rate fashion that ful-
filled my requirements of what I think a police department should
be.
Mr. CLYBURN. They've never had any incidents?
Mr. BAFFA. No, sir. But you have to understand that what I
wanted to do because it is a pilot, it was not something cast in
stone, we have 169 hospitals in 169 different locations. We have
some hospitals that are very large. We have some hospitals that
are very small.
Mr. CLYBURN. Is this a very small hospital?
Mr. BAFFA. Yes, sir, it is.
Mr. CLYBURN. And I understand that the crime rate in and
around this hospital is very low.
Mr. BAFFA. It depends on what your definition of low, sir, is. It's
below the 7.
Mr. CLYBURN. All things are relative. It's relative to what you'd
find in New York.
Mr. BAFFA. That's right. It is below the 7 of Manhattan.
Mr. CLYBURN. Right.
 14
Mr. BAFFA. Yes, it is below the 7.
Mr. CLYBURN. Is it 5, 6, 8?
Mr. BAFFA. Sir, I'll have to get that information back to you. It's
on the tip of my tongue. I don't have what the crime rate was
there.
Mr. CLYBURN. Thank you. I guess once again what I'm asking,
we're now walking through all this criteria that you've laid out
here and I'm trying to see how Hampton, VA fits.
Mr. BAFFA. Okay. I chose Hampton, VA, and sir, I hope I don't
confuse or"muddy the waters any more. If you were to ask me
places that I thought that we would have armed confrontation at
our facilities, I would have never chosen Lake City, FL, and we had
a police officer shot there. I would never have chosen Albuquerque,
NM. We had a police officer killed there. I would never have chosen
Brecksville, OH, which is a two-facility hospital, we have one in
Wade Park which in down in the inner city where all the police of-
ficers around-you know it's a hospital complex, the vast m~ority
of the police officers at facilities other than VA are armed. I would
have thought that that would have been the place that the police
officers would have been shot. They were not shot in Wade Park.
They were shot out in the suburbs at Brecksville.
Mr. CLYBURN. Go right ahead. I just don't want to encroach upon
my Chairman's time.
Mr. BAFFA. If I had a crystal ball, that's where I would put the
armed police officers. Matter of fact, if I had a crystal ball I'd be
at the Preakness Stakes Horse Race-you can't determine that.
The statistics will lie to you is what I'm saying.
Mr. CLYBURN. We understand that, and I think what our concern
is is that we don't initiate some emotional reactions to things. None
of us want to see any police officer shot, iIijured in any way. What
we also do not wish is for us to in search of a remedy that would
create greater harm. And I'm not too sure that we've not had these
kinds of situations in Sunday school on Sunday mornings. I read
of somebody being shot while sitting in Sunday"school or some-
thing. Things like this happen. That's part of the problem we have
in our society today, but we don't want to arm all the ushers in
church to make sure no one gets shot on Sunday morning. And so
we've got to be very careful. That's what I'm saying, that we have
to be very measured in this, and I have two big problems, one ex-
pressed by the Chairman, and that is, those of us on the sub-
committee, we want the best VA system that we can have and we
are very concerned that if we are looked upon as having some en-
tity out there separate and apart from everybody else doing its own
thing, that can cause us some real problems here in this Congress
and also with the public as well, to have your own training.
And as the Chairman has said, there are some things about
being a police officer that are standard, and I don't see anything
wrong with having that training standard and everybody having
the same training in the same way by the same groups and having
supplemental training for the hospitals. But to have everything
over here and have some incident come up and have us coming in
here and having people from Quantico or other places and come in
here and say, well, that's not the way you do that, you're supposed
 15
to do it this way, this way and this way. And have somebody from
the other academy telling us--
Mr. BAFFA. Yes, sir.
Mr. CLYBURN. Do you see what I'm saying?
Mr. BAFFA. Sir, I agree with you 100 percent, and I want to tell
you that all the concerns that you have articulated here in front
of me and as the Chairman has done, I have the same concerns you
do. I'm not talking about the training. I'll discuss the training. But
everything you've discussed before the trainin~, I agree with you
100 percent, and I know the Secretary agrees With you 100 percent.
What we're trying to do, and remember, this is a pilot program.
This is not cast in stone. It is a measured, I hate to use the term
experiment, but if you want to use the term experiment, that we're
trying to see if in fact this will provide a safer hospital community
or VA community. It's not cast in stone. I have the same concerns.
If anybody thinks that I think the answer to the question of
crime on VA property is to arm everybody, that's not the issue.
That's not where I'm coming from. That's not where the Secretary
is coming from. It's a measured study that we're looking at. I am
not saying I disagree with you so much on the core aspects, but
what I do have a problem with is Congress and legislation telling
me in Chapter 38, Title IX that training referring to VA police offi-
cers will have emphasis in situations dealing with patients. I agree
with you that after the basic training course that you're talking
about the core courses we could send ,o ur police officers to VA fin-
ishing school, for lack of better words. But my feeling is, and
maybe my colleagues here from FLETC will disagree with me, and
I will review it again. I looked at this issue in 1989 when I first
came here. I thought it was a no-brainer. I came from an agency
that trained at FLETC and I said, yeah, why not, and I wanted to
look at it. Later it came to me that the functions that they perform
are different than what the standard police officer performs on the
street. ' .
In addition to that, when you send somebody to a training acad-
emy, and you can talk of peer pressure and you say anything you
want and you're teaching them one way of training which includes
firearms which is a volatile issue. It's a volatile issue to this Com-
mittee; it's a very, very contentious issue with the police officers
themselves. And you give them their basic training which includes
firearm training or you omit the firearm training so you have 4 or
more people who do not participate in police training, you graduate
them, then what I would have to do I believe is send them to re-
tread school. I would have to disengage some of the things they've
learned and teach them the VA way.
I don't like the separatist status, what-have-you. If in fact we did
arm the police officers, to me in total, the Secretary would make
that decision, then to me that obstacle to include the training at
FLETC would make FLETC very, very attractive to me and I
would very, very highly consider it, and as I said, send my people
after that to the finishing school. Poor choice of words, but what
do they call the secondary? Follow-up finishing. Same thing.
Mr. CLYBURN. Follow-up?
Mr. BAFFA. Follow-up training at that perspective agency. I think
FLETC does a great job. I totally agree with you.
 16
Mr. CLYBURN. Let me yield to the Chair.
Mr. EVERETT. Thank you, Jim. At this point I'd like to introduce
another member of our. Subcommittee who also like myself and Jim
does not come from a political background, and that's Dr. Snyder.
Do you want to jump in here?
OPENING STATEMENT OF HON. VIC SNYDER
Mr. SNYDER. Yes, thank you, Mr. Chairman. Being on the Na-
tional Security Committee I have to choose between paying atten-
tion to the active side of the military when we have meetings at
the same time or the veterans' side of it and what I end up learn-
ing about is the traffic patterns on Pennsylvania Avenue as I run
back and forth between meetings. So, I apologize for not being
here, although I looked over some of the-statements that we were
given earlier this morning and have some familiarity I think with
what's going on. Just a couple of questions or comments. As having
both at medical school in Portland, Oregon and then in my resi-
dency in Little Rock, I trained at VA's and my experience there is
that in both those campuses as far as I was concerned and the ci-
vilian w.orld was concerned, you couldn't tell when you slopped over
from VA property onto State hospital grounds onto the medical
campus that was run by the State.
In Little Rock I do .ride along with a police officer sometimes and
we had a little fender bender and the police officer had to spend
time on the phone for about 15 .minutes trying to determine was
it State grounds, federal grounds or city-run streets. Those of us
who roamed through those campuses, we have two or.three law-en-
forcement folks that we run into. You run into your city folks, you
have your State medical center police, and then you have the VA
folks, and frankly, I didn't realize until the last 48 hours that the
VA ~olice were not armed, and I think there has to be a certain
conslstency there. I guess what I'm saying in a big way, I don't see
much problem with you going ahead with lour VA police carrying
firearms because frankly I think that woul have been the expecta-
tion at those campuses since you already have officers from the
other facilities carrying weaponry. That's just a comment. Any com-
ments you want to make would be appreciated.
The second point I wanted to make is, and now I am somewhat
biased I think, Mr. Chairman, being a family practitioner who
trained on those facilities, I think regardless of where the geog-
raphy is where they're trained at, the facility is in North Little
Rock [think, I think the treatment model needs to be part of the
training from the get-go on these officers. For example, and you all
I think have discussed one example, that of the inebriated fellow
who comes through the door. But obviously if you see a naked guy
on the street in downtown Washington, DC, your attitude toward
him is going to.be different than if you see a naked guy staggering
out the front door of a VA hospital. I mean, hopefully we will ap-
proach those fellows differently, and I think that from the get-go
you've got to have a different imprint in the minds of your hospital-
oriented police officers, and I'll have to leave to your training ex-
perts whether that means unlearning some things that traditional
police officers would learn. But I know that at the facility now,
wherever it is, that they currently are actively using people from
 17
the VA hospital that come over and talk and they stage simulations
of incidents that are going to occur in the hospital from the very
beginning, and I'm sure that that's going to be a different type of
training than if you're training people for 72 other agencies. But
that's a lot of rambling. Any comments you might have on any of
that I'd appreciate.
Mr. BAFFA. Sir, I'm very glad that 'ou made those statements be-
cause that is exactly the philosophy have. I think that people talk
and statistics being given about unarmed percentages I think Mr.
Clyburn gave me, in a lot of cases security guards aren't armed.
But I will use Miami or Cleveland, they have a security guard force
and they're supplemented by the Miami Police. In one case it's a
substation of the Miami Police on the hospital grounds. We have
to understand that the VA police are there as much for patient care
as they are for law enforcement, and it's a different type of law
enforcement.
You used an example, and I'd like to use another one, of my days
in the Secret Service. If we're outside the White House and you
saw somebody inebriated or naked, as you say, you had three
choices. You could tell them to move on and hope that his family
would take of him; you could arrest him for disorderly conduct; or
you would send him to St. Elizabeth's. But most of those kinds of
manifestations that happen on VA grounds are by veterans who
are there for that very treatment and we combine law enforcement
with the health-care community, and it has been my opinion but
I will readdress it again, that if we send people down to a training
academy first learning street police work for lack of better words,
street police work, and we build up their expectations and we don't
allow them to carry firearms or participate in firearms training,
then I'm going to have a heck of a time when you bring them back
to try to debrief them and get them into the health-care mode.
Mr. SNYDER. But by the same token, if we have any evidence
that the training that you all are doing is not adequate to deal with
a true street situation-I mean for example, I know that there are
sometimes nurses coming off work at hospital facilities are kind of
preyed upon--
Mr. BAFFA. Right.
Mr. SNYDER (continuing). By some bad actors out there.
Mr. BAFFA. Right.
Mr. SNYDER. Have we had any indication that the training you
all are doing on your VA police has not been adequate to handle
those kinds of situations, and if so that certainly is a dike that
needs to be plugged.
Mr. BAFFA. Sir, when I first came to the VA we were inadequate
because we were only giving them 64 hours training per/ear. We
were absolutely, positively inadequate. We: have develope a train-
ing course now which is 160 hours, and other than not being able
to respond to a patient or an individual because we can't get close
to them because we're being shot at, I know of no cases where we
have not effectively responded to a situation.
I guess I'm going to tell you if I might have the liberty of one
of the grievous cases that very, very concerns me totally when you
talk about arming the officer or not arming the officer, what-have-
you, and it happened a couple months ago in Dallas, Texas. And
 18
we had an ambulance driver, ambulance team, bring a patient in
on a routine case for surgery on a Monday morning. This was Sun-
day might; it was Monday morning. After they dropped him off, an
individual came on-the grounds with a shotgun and burst into the
emergency room. This ambulance driver was there, had nowhere to
go. He was a male, his accomplice was a female-not accomplice,
his partner was a female, and this man was brandishing a shotgun.
The VA police responded. They evacuated. As they tried to get near
the guy or talk him out of it, I'm not going to use the language he
used, put the gun to the female's head, "If you get any closer I'm
going to ..."-I'm not going to go any farther, but you can imagine
what he said to her. They backed off and they called the police to
respond. During that time he told the female ambulance attendant,
"Go out and get the ambulance and bring it here." The male ambu-
lance attendant said, "Let me do it." He said, "I'll kill her." The
male went out. At that time the guy let one round off in the hos-
pital with the shotgun. Our police could not get any closer because
every time they got closer he pointed the weapon at them.
To make a long story short, he kidnapped her before armed po-
lice could respond. He tortured her and raped her. Now, to me that
is wrong and we should not allow that to happen. And I think that
if we do this right, and Mr. Chairman and Mr. Clyburn, I want to
do what you want to do and I want to do it right. I think we can
prevent things like that from happening without endangering our
veterans or our customers, and I fully believe that.
Mr. CLYBURN. If I may, Mr. Chairman.
Mr. EVERETT. Certainly. Go ahead, Jim.
Mr. CLYBURN. I've always had a real, real problem with making
laws and rules and regulations based upon anecdotal stuff. That's
a horrible situation, but you know, at the VA Hospital Center in
Columbia the incidents like that were domestic. We've had a few
of those. Now, I don't know if that was the 1992 instance you're
talking about here, but were the husband and wife causing the
problem?
Mr. BAFFA. No, that's another incident. The one in Columbia that
I'm familiar with is when the niece called and said the patient had
gotten the bus and was coming to kill the doctor because he didn't
give him the right prescription that he was looking for. The bus
stopped right in front of the hospital as you're familiar with.
Mr. CLYBURN. Right.
Mr. BAFFA. The VA police called the Columbia-have them help
respond. Unfortunately, he was on the bus. He was literally on the
bus. The VA police confronted him and a police officer was shot.
Mr. CLYBURN. Well, that's what I'm talking about. When the wife
called why was not the Columbia Police Department called?
Mr. BAFFA. They were. They were busy and could not respond.
They did respond. The Columbia Police Department did respond
too late. That's not the fault of the Columbia Police Department.
They had their police officers doing other things.
(See attached letter.)
 19
DEPARTMENT OF VETERANS AFFAIRS,
DEPUTY AsSISTANT SECRETARY FOR SECURITY AND LAw ENFORCEMENT,
Washington, DC, June 24,1997.
Hon. TERRY EVERETT,
Chairman, Subcommittee on Oversight and Investigation, Committee on Veterans'
Affairs, -
House of Representatives, Washington, DC.
DEAR MR. CHAIRMAN: After reviewing the transcript of my testimony of May 22,
1997 during the hearing on Safety and Security. I realized that there was an error
in my testimony relative to the events of the police officer that was shot in Colum-
bia, South Carolina. I confused this incident with another shooting incident that oc-
curred at one of our facilities in the South.
In my testimony, I stated to Congressman Clyburn that the City of Columbia Po-
lice Department was notified but they responded too late to avert the shooting. This
was incorrect. The VA Police did not have time to call the Columbia Police Depart-
ment as they had to rush to the main hospital entrance where the alleged subject
was to arrive on the scheduled bus, as telephoned in by the suspect's niece a minute
earlier.
The Columbia Police Department responded within a few minutes after they were
notified of shooting. I am sorry for any inconvenience this error might have caused.
Sincerely,
JOHN H. BAFFA

Mr. CLYBURN. I understand. I remember the incident and I did

not believe, on<:e again to deal with it anecdotally, that that inci-
dent although it's mentioned here, I think there was a much better
response than the VA officer having a gun. Now, my mind is not
made up about whether or not they ought to be armed. That's not
my problem here.
Mr. BAFFA. I understand that, sir.
Mr. CLYBURN. My problem here has to do with training--
Mr. BAFFA. Yes, sir.
Mr. CLYBURN (continuing). Has to do with recruitment.
Mr. BAFFA. Yes.
Mr. CLYBURN. It has to do with whether or not the officers that
you have hired when you recruit them where they come from. Drug
testing. Training. All of those things that ought to go into trying
to determine whether or not this is the kind of person that ought
to be a police officer.
Mr. BAFFA. I agree with you, sir.
Mr . CLYBURN. And then once the decision is made on this person,
what kind of training this person will have before having this sup-
plemental training I like to call it that would be required for the
VA. Because let me tell you something. It may not be in your
records, and you may not recall these incidents, but I know of more
than one incident on a facility at the VA that had absolutely noth-
ing to do with anybody that wanted to rape anybody, it had to do
with a husband and wife that wanted to get rid of one another, and
one of them happened to work at the VA hospital and the incident
occurred.
Mr. BAFFA. Absolutely. Domestic disputes are horrible.
Mr. CLYBURN. That's right. Now, the problem here is that we all
know that that's the worst kind of situation to be in with a gun.
Mr. BAFFA. Absolutely. Absolutely.
Mr. CLYBURN. I certainly know that. And there's a lot of that
going on at the VA's. So, I want to be very, very careful and meas-
ured about this, and that's my real concern here. So, I certainly
don't want us without any empirical data to get into this just be-
 20
cause we've had some incidents, just because somebody's emotions
are running high, just because we have a lot of handcuffs to throw
around. I just am very careful.
Mr. BAFFA. Sir, I agree with you and I would like to make one
comment, and the Director of Jackson would like to say something.
The decision to arm VA police officers was-made well over a year
ago and before any of these incidents, i.e., what happened in Albu-
querque, NM, what happened in Jackson, MS occurred. That deci-
sion was made I believe a year and a half ago to begin the imple-
mentation of pilot test sites. So, it wasn't a knee-jerk reaction type
situation. And I will say that, and I personally tell you that I agree
as does the Secretary with all your concerns. I'd like to tum over
one thing to Mr. Miller.
STATEMENT OF RICHARD MILLER
Mr. MILLER. Thank you, Mr. Baffa. I'm Dick Miller. I'm the Di-
rector of the G.V. "Sonny" Montgomery VA Medical Center in Jack-
son, MS, and I too, Mr. Clyburn, have the same concerns about
arming VA police. And I can say that yes, there was some emotion
involved in that, but we went through an awful lot of agony and
looking at our organization, a lot of fact-finding before I asked Mr.
Baffa to present our consideration to the Secretary for arming our
police. We have 17 police officers presently at the Jackson, G.V.
"Sonny" Montgomery VA Medical Center. Sixteen of those have
prior police experience. Eleven of those have been with the VA for
under 6 years. Sixteen of those have been at the VA for under 10
years. Combined they have 247 years and 2 months of police expe-
rience. Of that 247 years and 2 months, they have 67 years and
7 months in the VA. Our average experience of our police force is
14.5 years. They have all or will in addition to having that experi-
ence in recognized police organizations in the country, they will go
or have gone through the now 5 weeks training at our police acad-
emy.
One of the significant considerations was the quality of the police
force at Jackson that helped me in changing my opinion about arm-
ing our police force in the hospital. A hospital is a place of healing.
There's no doubt about that. But in some areas when the sanctity
and the sanctuary of that has been violated as it has been, our
staff and our community cry out for something.
Mr. CLYBURN. May I ask you a few questions about your police
force? Tell me a little bit about how you hire those people.
Mr. MILLER. Ironically, sir, it started about 5 years ago, just a
couple years after Mr. Baffa started to initiate a lot of changes. We
had a police force that did not have very good, effective leadership.
It was not very schooled, did not have a lot of experience, and it
happened before I got there. I've been there just about 3 years. It
will be 3 years this August. But the then chief operating officer, my
associate director, had already started to initiate the change in the
improvement. We started by being very fortunate in hiring a man
that had extensive military experience, 22 years, as our police
chief.
As I mentioned to you, we have 11 police officers that have less
than 5 years' experience in the VA. We have 16 police officers that
have less than 10 years' experience in the VA. So, with our search-
 21
ing for those experienced personnel and having those people that
qualify but also came to us with tremendous experience, we were
fortunate to select very talented, well-trained, formerly exposed to
the academy police officers.
This is ironic, but since the terrible event February 19th of this
year with the murder of Dr. Carter and the suicide of Mr. Bowles,
a veteran, the number of applicants in the OPM area in Georgia
has gone up. The type of quality that we are receiving has gone up.
We've hired three police officers with experience from the City of
Jackson. Quite frankly, they came to us I believe because of the un-
fortunate press we had about the questions we had of why weren't
our police officers armed and the fact that I said that I was going
to increase my police force by at least 50 percent. And I just talked
to one of them the other day who had 14 years of police experience
in the Jackson Police Department, and I chatted with him, asked
him about his family. And he said, "You know, Mr. Miller, I can't
believe how wonderful a place this is and how caring the people
are. And I'm so happy to be here because it's the first time in 12
years I feel good about coming to work." So, our mission is a heal-
ing mission, and that is what we're there for.
Mr. CLYBURN. But didn't he carry a gun when he was with the
Jackson Police Department?
Mr. MILLER. Yes, he did. And every one of these people I'm talk-
ing about carried guns in some police force.
Mr. CLYBURN. That's maybe why he feels so good about coming
to work.
Mr. MILLER. No, he's referring to what he was going through
when he was on the streets.
Mr. CLYBURN. I'm just being a little bit facetious.
Mr. MILLER. Incidentally, I'm remiss in that I'm late in coming
here and just presented the Committee with a statement and I'd
like to have that included in the record if I could.
Mr. CLYBURN. Without objection.
[The prepared statement of Mr. Miller appears on p. 239.]
Mr. CLYBURN. Do you have drug tests and that kind of stuff for
the police officers?
Mr. MILLER. The present system of drug testing that we have in
the Veterans' Administration for our employees are for new hirees
by random pulling of their social security number, and I'm remiss
in remembering the date, but sometime this summer we will go to
the random testing for all employees. So, it won't be just new hires.
But our police officers go through an extensive physical once a
year, and they also go through a psychological assessment and if
that psychological assessment indicates concern for further psycho-
logical testing, that's done.
Mr. CLYBURN. Is that done annually?
Mr. MILLER. Yes, sir.
Mr. CLYBURN. The psychological testing?
Mr. MILLER. Yes, sir.
Mr. EVERETl'. In the previous question did I understand that it
is for new hires but you would also include people on the force?
Mr. MILLER. Sir, right now all new hires are randomly tested.
Mr. EVERETl'. How about out of the folks that have been there
a while?
 22
Mr. MILLER. Beginning this summer all-and I don't know all
the different categories, but the police officers are included in that
category, will be subject to random drug testing. In addition with
police, if the chief of police notices something unusual about that
behavior pattern of that officer, he can mandate that that police of-
ficer be drug tested.
Mr. EVERETl'. I'm going to ask you to notify this Committee when
that happens, and notify this Committee in any event in 90 days.
Mr. MILLER. Yes, sir.
Mr. EVERETl'. Mr. Miller, I recognize that you don't have a crys-
tal ball and perhaps you've not talked to all hospital directors
across the nation or done a survey, but if I asked you today to
make an educated guess or an opinion, would you say that other
directors are in favor of arming their police officers, the majority
of them, or the majority of them would be in disfavor?
Mr. .MILLER. I can speculate that those directors perhaps are at
the same position I was prior to February 19th of this year and
maybe would not do that. But I also feel very strongly that, again,
it wasn't an emotional reaction. It was a very thorough, studied re-
action. We talked to our complete medical staff, our nursing staff,
other staff, members in the community, opinion leaders in the serv-
ice organizations and in the community, and I lost a lot of sleepless
nights debating. But I can tell you that one thing that continuously
rings in my head is that staff physician looked at me and said, "Mr.
Miller, something may happen to us outside the walls and doors of
this institution, but we have 120 physicians, the system has 26,000
physicians. The two most violent acts against physicians in our sys-
tem in the last 5 years, and indeed in the last 3 years, happened
at the Jackson VA Medical Center." We can't look anyone else in
the face, I can't look at another wife and a 12-year-old and a 6-
year-old child in the face and say I didn't do everything I possibly
could to make the environment a sound and safe one. And I'm not
foolish to think that guns are going to stop things like that. If
somebody wants to do that, they're going to do it. But I think for
the psychology of the organization that's been wounded gravely and
will have a tough time going through this, that those steps are nec-
essary at the Jackson VA Medical Center.
Mr. EVERETl'. While I appreciate the position that you're in, the
ranking member and I are both very sensitive though about this
camel getting his nose under the tent, frankly.
Mr. MILLER. Right.
Mr. EVERETl'. And these things have a way, and this is my third
term. As Jim said earlier, we both come from nonpolitical back-
grounds. I spent 30 years in the newspaper business and the busi-
ness world before coming here, and I'm not sure that we can in the
society we live in today have everybody walking around with guns
to protect society. And I understand the heartbreak, I know some
of it personally, that comes along with having to look a wife in the
face and tell her or her loved one, the patient, and tell them what's
happened. I understand we've got five test pilot programs under-
way right now with three others planned.
Mr. BAFFA. Sir, effective today we have six. We just started
Hampton today. And I'm looking at with Jackson, they'll on line in
a couple of weeks. That would be seven. And the Secretary has au-
 23
thorized me to look to do up to 10. The only decision I have made
has been on those seven. I have not made a definite decision on the
additional three at this time. I haven't had time, to be honest with
you.
Mr. EVERETT. I would also request to you that if as you begin or
make the decision to put any other facilities on line that this Com-
mittee be notified.
Mr. BAFFA. Absolutely. Yes.
Mr. EVERETT. In addition to that, I would like to know prior if
a decision is made to expand this program, the pilot program, be-
yond its current confines. /
Mr. BAFFA. Yes, sir. Yes, sir.
Mr. EVERETT. Let me get a couple quick questions and then if
Jim doesn't have any more to answer we'll move on to a couple
other things. The VA policy on the pilot programs says shooting in-
cidents will be reported immediately.
Mr. BAFFA. Absolutely.
Mr. EVERETT. Who are they reported to and what does imme-
diate mean?
Mr. BAFFA. Immediate means as soon as the situation is neutral-
ized and everybody is safe, they are to pick up the phone and notify
the local FBI, my office which has a 24-hour answering capability
with an answering service. We have Mr. Harper who works for me
and a duty agent assigned, rotating duty agent, and the Secretary
of Veterans Affairs will be notified.
Mr. EVERETT. I would ask that in the immediate notification that
this Subcommittee which has oversight in investigation be notified
and given full details of any such occurrence and that we be put
on the immediate notification list.
Mr. BAFFA. Yes, sir.
Mr. EVERETT. I want to ask. I recognize it's hypothetical and I
don't like answering hypothetical questions myself, but neverthe-
less it is one I think like that we must bring forth. That is, what
circumstances would it be proper for an armed VA police officer to
kill a veteran in a VA hospital? And don't tell me that that's not
a possibility because we all know that it is a possibility.
Mr. BAFFA. No, sir, I know it's a possibility. As I said, I have
been in law enforcement for 27 years and unfortunately was in-
volved in a shooting and it's not a pleasant site.
Mr. EVERETT. I understand. I have relatives that are in law en-
forcement too and I know exactly where you're coming from.
Mr. BAFFA. Mr. Chairman, I am going to answer that question.
I'm not going to try to sluff it. I'm going to give you an answer.
But the first thing I'd like to say is that our VA police officers,
we've come a long way and I think we've got a good force and I
know it's not always important what I think, but it's what you
think, and I invite you to come out to our facilities at any time and
look at them. Our VA police don't want to kill anybody, and I don't
think there's a law-enforcement agency anywhere that wants to kill
anybody.
Mr. EVERETT. I would suggest to you that no law-enforcement of-
ficer would want to kill anybody.
Mr. BAFFA. That's correct.
Mr. EVERETT. Let me finish, please.
 24
Mr. BAFFA. Sorry. Excuse me.
Mr. EVERETl'. My question is very direct. Do you have criteria of
when a VA armed officer would be allowed to kill a veteran in a
VA hospital? And be as direct as you can.
Mr. BAFFA. All right, sir, I'll be very direct with you. Officer
Hoerst Woods was a police officer and a veteran. I think it would
have been proper for him to shoot at his assailant who was a
veteran.
Mr. EVERETT. And anytime we shoot we assume that we're going
to kill someon~
Mr. BAFFA. That's correct. We shoot to neutralize.
Mr. EVERETT (continuing). And we should not shoot otherwise.
Mr. BAFFA. That's correct.
Mr. EVERETT. Jim, before we leave his do you have anything else
you'd like t<r--
Mr. CLYBURN. Yes, sir, I have two--
Mr. EVERETT. Certainly. Go right ahead.
Mr. CLYBURN (continuing). Issues I'd like to cover. First of all,
Mr. Chairman, due to last minute notice, the International Associa-
tion of Fire Fighters has asked to submit testimony by Friday.
They will discuss the- status . of fire departments at VA facilities. I
ask you 'now to accept that their testimony be part of the hearing.
Mr..EVERETT. Without objection. So ordered.
[The testimony of the International Association of Fire Fighters
was not received by the subcommittee.]
Mr. CLYBURN. Also Mr. Chairman, we had this information sub-
mitted to us. There are some things in here that I think may be
of assistance to us with this hearing here today. I ask that this doc-
ument be made a part of the record.
Mr. EVERETT. And that is a document from the Department of
Veterans Affairs?
Mr. CLYBURN. Yes, sir. It's in the record.
Mr. EVERETT. It's in the record now? Yes.
(See p. 92.)
Mr. CLYBURN. Thank you. Let me ask if I may about the inci-
dents. When you have a pilot project you're trying to gather infor-
mation and that information is to be used for the purpose of estab-
lishing first of all whether or not you're going to go forward with
a broad application of this and if so how you're going to do it. I'm
a little bit concerned as to how will you determine whether or not
this pilot has been a successful pilot and the conditions that you
will find which will determine whether or not you go with a meas-
ured program, that is, a center-by-center program, or a program for
all of the centers. Have you all developed an instrument that we
could have or that we would know would assist us in being a little
more intelligent about what it iSlou're doing?
Mr. BAFFA. Absolutely, sir. Were in the process of developing the
criteria used to be made in the evaluation. It will include at this
present time but not limited to the amount of activity, i.e., more
police stops, more proactive law enforcement being accomplished.
We will talk to the service organizations at the facilities. We will
talk to the veterans at the facilities. We will talk. to the local com-
munities, the local police. We will talk to the staff. And we will
then document all incidents as you articulated. We will compile
 25
that. We will meet with Dr. Kaiser and the Secretary, give him the
information now that you've asked, we will give you the informa-
tion, and that's how we will make the determination.
Mr. CLYBURN. When you're saying incidents, let's just suppose
that during this time frame, I don't know what the time frame is.
Mr. BAFFA. Sir, initially it was going to be a year which would
have ended October 1, but inasmuch as we've added five facilities,
I'm going to ask the Secretary if we could extend it to February.
Mr. CLYBURN. February 1998?
Mr. BAFFA. Yes, sir.
Mr. CLYBURN. And then at the end of that period you're going to
do some kind of evaluation of all those. Let's just suppose no inci-
dents occur during that period. I would say that by most methods
we use to measure things, we say, hey, outstanding program, ex-
actly what we intended to achieve, no incidents, the thing is work-
ing, let's do it everywhere. Now, the problem with that is 5 years
ago there may have been a period of 12, 18 months where no inci-
dents occurred. So, tell me which one was successful, that period
of time with no guns, or a period of time with guns?
Mr. BAFFA. Sir, that's an excellent question, and I think that I
agree with you. If we went in with this preconceived notion of what
we wanted to do as far as arm all the police officers you articu-
lated, you would be absolutely correct and it would be valid for you
to come back and say, well, what about 5 years ago when you
didn't. That's not how we're looking at this. My goal is to protect
the veteran the best way possible, and I assume you that before we
make the evaluation we will give you all the information and give
you the criteria and you being on the Oversight Committee, I'm
sure you'll want to look into the criteria and have questions about
it. This is an open, honest attempt. There's nothing under the blan-
ket here. I'm not going to tell you that, yes, I think I would like
to arm the police officers. But I do not believe, have never believed,
that I want to go out en masse and arm police officers. I'm looking
at this like I've looked at everything else as an action that needs
to be taken and looked at.
I'll tell you, sir, when we developed the K-9 program and started
putting dogs on campus, people accused me of being a brown-
shirted Nazi because we were introducing dogs on campus. They
had visions of Alabama and Birmingham. Our dogs aren't like that.
They're passive-aggressive dogs. The problem we have now is the
veterans want to feed the dogs and take care of them and keep
them from doing their business. So, we have no preconceived no-
tions of thi~, sir. I don't know if I'm under oath or not, but I am
telling you we have no preconceived notions and we will allow this
Committee to look at what our criteria is and how we made the
decision.
Mr. CLYBURN. Do you have K-9's at every facility?
Mr. BAFFA. No, sir. It's an optional program.
Mr. CLYBURN. So, that was something left up to each director-
Mr. BAFFA. That's correct.
Mr. CLYBURN (continuing). As to whether or not he or she want-
ed K-9's?
Mr. BAFFA. That's correct.
 26
Mr. CLYBURN. And the purpose of the K-9's, of making that op-
tion, what were the purposes?
Mr. BAFFA. You mean why did we leave it an option?
Mr. CLYBURN. Yes. Why did you even introduce it?
Mr. BAFFA. Well, for two reasons. I'm a firm believer, and as I
go back to before, it doesn't do me any good to shoot somebody after
they've already shot somebody else: I mean, I've shot the person
who shot somebody. What we want to do is have preventive law
enforcement.
Mr. CLYBURN. That's what I'm asking. So, the K-9's are part of
some kind of prevention program.
Mr. BAFFA. Preventive.
Mr. CLYBURN. They're not sniffing in lockers to see whether
there--
Mr. BAFFA. Excuse me, sir. Their primary functions are, number
one, missing patient searches. We have a lot of campuses that are
very large.
Mr. CLYBURN. True.
Mr. BAFFA. A dog is very effective in that.
Mr. CLYBURN. Right.
Mr. BAFFA. The second function is drug interdiction. Illegal drug
interdiction.
Mr. CLYBURN. Right.
Mr. BAFFA. Those are the two primary functions of dogs on VA
campuses.
Mr. CLYBURN. Well, that's what I was trying to get to.
Mr. BAFFA. Yes, sir. I'm sorry. I didn't understand the question.
Mr. CLYBURN. Thank you, Mr. Chairman.
Mr. EVERETT. Thank you, Jim. Let me ask this one final ques-
tion. As you know, the Veterans' Benefits Administration is co-lo-
cating some regional offices in VA medical center campuses. Am I
correct in understanding that the co-located regional offices are
contracting for their own security when the VA hospital police are
already providing security on the same campus? ,
Mr. BAFFA. You're partially correct, sir. What has happened is
that we had some facilities that were contracting out their services.
They found out it wasn't working properly and they're now being
monitored by VA police. There are two other facilities that I be-
came aware that that was an upcoming issue that they were plan-
ning to do that. It was last November I became aware of that. I
sent a document to General Counsel for some clarification on the
legalities of that. I have not gotten a final response. I have Mr.
Hall from General Counsel. And it is my belief that that whole
issue has been resolved and is being resolved and that it's a co-lo-
cated facility. We are one VA and that facility will be secured by
VA police to the best of my knowledge at this date.
Mr. EVERETT. And you're telling this Committee that the VA se-
curity people will at some point assume all the responsibility for all
of VA?
Mr. BAFFA. That is correct, sir, and if anything changes on that
I will notify the Committee.
Mr. EVERETT. I appreciate it because I'll be honest with you, I
don't know if this is a turf battle or what, but this member has had
 27
about all the turf battles he can put up with during the last 4
years.
Mr. BAFFA. I agree with you, sir. .
Mr. EVERETT. Let me move on quickly to-we will submit some
other questions, by the way. We're very interested in the cemetery
situation, the security there, and because of the length of this hear-
ing and we still have panels to go to, we will submit some more
questions for record concerning that. Mr. Ogden, if I may, in 1992
the VA's Inspector General made several recommendations for im-
proving security at VA hospital pharmacies. Please briefly describe
his recommendations and what you've done to implement them.
Mr. OGDEN. Good morning, Mr. Chairman, and I'd be happy to
do that. In our testimony we elaborated on the issues that the In-
spector General and the General Accounting Office and this Sub-
committee identified in that time period, and the testimony I think
articulates what we've done. What I would like to do is just sum-
marize and say that the VA program today regarding, specifically,
controlled substances and, less so but just as significant, noncon-
trolled substances, is certainly changed-it's a different world in
1997 than it was in 1991, and I think you'll see that what we said
we were going to do we have done to the greatest extent possible.
Some of the issues haven't been totally resolved because some of
them are software driven, but I think we have procedures, policies,
etc., concerning controlled substances accountability that are very
stringent. Some of them are onerous to the staff, but I think you'll
see by looking at the Inspector General cases that have occurred
in the last few years that no significant volumes of controlled sub-
stances have been diverted, and we're confident that as we change
the VA health-care system and move from a hospital-based empha-
sis to community-based clinics, etc., etc., that we will reassess our
system and continue to address these very important issues.
Mr. EVERETT. Let me ask you, where do stolen VA drugs typi-
cally wind up, say from any particular institution? Does it stay in
that community? . .
Mr. OGDEN. Well, I can just give you my opinion, maybe Mr.
Baffa might give you his opinion. My opinion would be that prob-
ably both. It depends, if the stolen property is for personal use or
for family members, or if it was large scale it would probably be
for resale on the street.
Mr. EVERETT. Do you concur?
Mr. BAFFA. Yes, sir, and I will note that since the last hearing
on drugs which I believe was 1992, we have not had a successful
break-in burglary of any VA pharmacy. Any drugs that have gone
array have been through diversion.
Mr. EVERETT. Is the problem generally inside though and not
break-in's? Inside the VA itself?
Mr. OGDEN. You mean the problems of missing drugs probably
has been, yes, sir.
Mr. EVERETT. How about security of prescription pads?
Mr. OGDEN. Well, I think the prescription pad issue is always
going to be with us just like it's with society in the health-care sys-
tem at large. We have modified the VA prescription form twice
since 1991-1992. And in addition to that, we also have encouraged
other alternative method of writing prescriptions to include elec-
 28
tronic prescriptions as well as prescriptions specifically as written
on computer forms that come out of our DHCP health-care system.
Mr. EvERETT. I appreciate the indulgence of this panel. We will
have additional questions on a number of issues that we've dis-
cussed here today, and at this point I want to thank you again for
showing up and we will now move to the next panel.
Mr. BAFFA. Thank you, Mr. Chairman.
Mr. EVERETT. Mr. Baffa, I realize that the VA's pilot program
has essentially an evolving process. You've heard our concerns
about arming hospital police, the department's undertaking an ex-
periment and allowing the use of lethal force at its hospitals as a
deterrent. Constant vigilance, close supervision by the VA during
this pilot project is an absolute necessity. This Committee wants to
be notified of any shooting incident as we mentioned immediately.
Also please provide for our review your 6-month and I2-month
evaluation of your pilot facts.
And with that we do welcome the next Committee, Mr. Joseph
Wolfinger, the Assistant Director of Training Division, Federal Bu-
reau of Investigation, and if you would please introduce your fellow
panel members.
STATEMENT OF JOSEPH WOLFINGER, ASSISTANT DIRECTOR
OF THE TRAINING DMSION, FEDERAL BUREAU OF INVES-
TIGATION; STATEMENT OF CHARLES F. RINKEVICH, DIREC
TOR, FEDERAL LAW ENFORCEMENT TRAINING CENTER, DE
PARTMENT OF TREASURY
STATEMENT OF JOSEPH WOLFINGER
Mr. WOLFINGER. Well, my name is Joe Wolfinger. I'm the Assist-
ant Director in Charge of Training for the FBI, and Charlie
Rinkevich who is the Director of the Federal Law Enforcement
Training Center at Glynco, GA, is with me.
Mr. EVERETT. If you will, Mr. Wolfinger, proceed with your testi-
mony and if you would limit it to 5 minutes, we'll put your com-
plete testimony into the record. '
Mr. WOLFINGER. Certainly. Good morning Mr. Chairman and
members of the Committee. I understand that I am here today to
provide this Committee with information about FBI training, and
specifically our firearms training program. The FBI's new agents
training program is a I6-week course of instruction focusin~ in four
core areas: academics, physical training, practical application, and
firearms training. This equates to approximately 654 hours of in-
struction of which firearms training accounts for approximately 116
hours divided into 28 sessions. I think it is important to note that
in general the mission of Special Agents of the FBI is different
than that of a federal police officer and therefore our training is
different. Agents are generally not first responders, nor do they
routinely patrol. Likewise, our basic qualifications and selection
process are different from other law-enforcement organizations.
A Special Agent's training does not stop at the conclusion of new
agent's training. After reporting to their first office of assignment,
a Special Agent begins a 2-year probationary period durin~ which
the new Special Agent receives on-the-job training from Semor Spe-
cial Agents. During this period the new Special Agent is expected
 29
to perform specific functions of his or her job to include testifying,
writing affidavits and so on, and is evaluated on performance. If for
any reason the probationary Agent is dismissed, there is no appeal.
Additionally, all Special Agents are required to qualify four times
a year with their issued weapons and the weapons they have sub-
sequently been authorized to carry.
I would also like to clarify that the FBI does not certify or ap-
prove of the organization's instructions to include firearms train-
ing. We have in the past offered and provided FBI instructor train-
ing to personnel from other organizations. Having said that, I'd like
to provide you with an overview of the new agent firearms training
curriculum.
The primary mission of the firearms training unit is to train new
Agents to become safe and competent shooters with Bureau-issued
handguns, shotguns and carbines through a 16-week, three-tiered
training program consisting of fundamental marksmanship train-
ing with all three weapons systems, combat survival shooting in-
corporating all three weapons systems on progressively complex
and challenging courses, and judgmental shooting.
The firearms training unit at Quantico also administers fire-
arms-related training programs for Agents assigned to FBI head-
quarters, the Bureau's 56 field offices, and the law-enforcement
community.
During firearms training students will fire a total of 4,395
rounds. Nearly 3,000 rounds will be fired during the course of 19
sessions as students master basic marksmanship skills and qualify
for the first of two required times with a shotgun, handgun and
carbine. During the remaining nine sessions students will fire ap-
proximately 1,400 rounds as their skills are challenged during com-
bat survival training in their preparations for final qualification.
The combat survival portion of the firearms curriculum includes
judgmental training along with combat courses which include no
shoot targets and other courses where students must work as
teams to resolve complex shooting problems. Students are exposed
to at least 12 computer-driven scenarios with which they must
interact and if appropriate employ deadly force. Unsafe, unpro-
fessional or inappropriate behavior during these scenarios or at any
other time during firearms training may result in a recommenda-
tion for a new agent review board or outright dismissal.
Student performance is assessed constantly during firearms
training. When appropriate, students are given individualized in-
struction. If a student should fail to qualify, they are given 2 weeks
of intensive remedial training after which they are afforded an-
other opportunity to qualify. Failure at this juncture would result
in dismissal from training. I'm very proud to note that the Training
Division of the FBI has not lost a student because of a firearms-
related failure since 1990.
In addition to successful completion of the initial firearms train-
ing, all Agents are required to attend firearms training and qualify
four times a year throughout their careers. A minimum of 1,000
rounds is budgeted for each Agent for this purpose during each
year to ensure that our Agents maintain this critical but perishable
skill.
 30
Agents who fail to satisfy minimum requirements lose their au-
thority to c~ firearms until the deficiency is resolved and the
risk of availability pay should that deficiency persist. Because the
loss of pay is such a strong incentive, this has not been an issue.
As I said earlier, the new Agent firearms training curriculum
consists of 116 hours of classroom and range instruction broken
down into 28 sessions. These sessions are very much interrelated
and complement training conducted by physical training, practical
applications and our legal instructions unit. Our firearms training
is multi-dimensional. It is concerned not only with an ~ent's accu-
racy and proficiency with weapons, but also focuses on tIie relation-
ship inherent to having the power and authority of applying deadly
force. It is an intense, integrated training program focusing on
awareness, judgment and skill.
[The prepared statement of Mr. Wolfinger appears on p. 44.]
Mr. EVERETT. Thank you, Mr. Wolfinger. Mr. Rinkevich.
STATEMENT OF CHARLES RINKEVICH
Mr. RINKEVICH. Thank you, Mr. Chairman and members of the
subcommittee. It's a pleasure for me to be here to discuss with you
the operations of the Federal Law Enforcement Training Center.
As you know, the FBI is a Bureau of the Department of Justice,
but the Federal Law Enforcement Training Center is a Bureau of
the United States Department of the Treasury.
Conceived as part of the great urban and police reforms of the
1960's, the FLETC opened its doors in 1970. Its headquarters have
been housed since 1975 on a 1,500-acre former Navy training base
located just outside the city of Brunswick, GA, on Georgia's south-
east coast, at Glynco, GA. The FLETC also operates two satellite
training facilities, an owned facility at Artesia, NM, and recently
opened a licensed temporary facility at Charleston, SC.
Born from the need to provide federal law enforcement with con-
sistent, high-quality training and nurtured through its infancy by
a combination of interagency cooperation and support, the FLETC
has matured into the largest, most cost-efficient center for law-en-
forcement training in the nation. Center facilities at Glynco include
a modern cafeteria, regular and special-purpose classrooms, dor-
mitories capable of housing more than 1,200 students, office and
warehouse space, and state-of-the-art specialized training facilities
for physical, driver/marine and firearms training. Our Artesia site
has much the same facilities but on a much smaller scale.
The FLETC's mission is to conduct basic and advanced training
for the majority of federal government's law-enforcement personnel.
We also provide training for State, local and internationallaw-en-
forcement personnel particularly in specialized areas and support
the training provided by our participating agencies that are specific
to their needs. The Department of Treasury has been the lead
agency for this facility and provides the day-to-day administrative
oversight and direction to FLETC since its creation.
Using a multidisciplined faculty that includes criminal investiga-
tors, lawyers, auditors, researches, education specialists, police and
physical security personnel, the center provides entry-level pro-
grams in basic law enforcement for police officers and criminal in-
vestigators along with advanced training programs in areas such as
 31
marine law enforcement, antiterrorism, financial and computer
fraud, and white-collar crime. Currently, 70 federal agencies par-
ticipate in more than 200 different programs at the center.
Both the center and its work load have grown tremendously over
the years as more agencies have come to realize the many benefits
of consolidated training. In 1975 when FLETC relocated from
Washington, DC, a staff of 39 employees moved with the center.
Today the FLETC has an authorized staff of 512 permanent em-
ployees. Additionally, there are more than 150 personnel detailed
to the center from its participating organizations. Several of the
center's participating organizations also maintain offices at Glynco
with a total staff complement of over 600 employees, and employ-
ees of the center's facility's support contractors total more than
700.
Training is conducted at either the main training center in
Glynco, GA, our satellite training center in Artesia, NM, or the
temporary facility I mentioned at Charleston. The temporary train-
ing center at Charleston was established in 1996 to accommodate
an unprecedented increase in the demand for basic training, par-
ticularly by the Immigration and Naturalization Service and the
Boarder Patrol. In addition to the training conducted on-site at one
of FLETC's residential facilities, some advanced training, particu-
larly that for State, local and international law enforcement, is ex-
ported to regional sites to make it more convenient and/or cost-effi-
cient for our customers.
Over the years the center has become known as an organization
that provides high-quality and cost-efficient training with a can-do
attitude and state-of-the-art programs and facilities. During my as-
sociation with the center I've seen first hand the many advantages
of consolidated training for federal law-enforcement personnel, not
the least of which is an enormous cost savings to the government.
Consolidated training avoids the duplication of overhead costs that
would be incurred by the operation of multiple-agency training
sites. Furthermore, we estimate that consolidated training will
save the government over $180 million in per diem costs alone dur-
ing 1998. That estimate is based on our projected 1998 work load
and the per diem rates in Washington and other major cities of
$152 a day versus the cost of housing, feeding and agency mis-
cellaneous per diem at Glynco of slightly more than $25 a day.
Consolidation also ensures consistent high-quality training and fos-
ters interagency cooperation and camaraderie. Students from the
different agencies co-mingle, thus learning about each other and
each other's professional responsibilities. These networks establish
at the center last throughout their careers.
We view FLETC and consolidated trainin~ as a National Per-
formance Review concept ahead of its time. Quality, standardized,
cost-effective training at state-of-the-art facilities, interagency co-
operation and networking are indisputable results of consolidation.
The Administration and Congress can be proud of the quality of
training being produced at the center and the cost savings realized.
FLETC is essentially a voluntary association with each agency's
participation governed by a memorandum of understanding and
bolstered by the commitment of the participating agencies, the De-
partment of Treasury and the Congress. particularly in these times
 32
of several budget constraints, a single agency cannot afford the so-
phisticated facilities and staff which are required for state-of-the-
art training necessary to adequately prepare our nation's law-en-
forcement personnel. Only by consolidation at a centralized location
are programs and facilities like those at FLETC economically fea-
sible. We estimate that it would cost in excess of $175 million just
to duplicate the facilities available at Glynco.
Mr. Chairman, in closing I'd like to emphasize that the Depart-
ment of Treasury and the FLETC management are strongly com-
mitted to providing high-quality training at the lowest possible
cost. Substantial savings are being realized by the government
through the operation of our facility. And now I'm available to an-
swer any questions you may have. Thank you.
[The prepared statement of Mr. Rinkevich appears on p. 54.]
Mr. EVERETT. Thank you very much, gentlemen. Mr. Wolfinger,
in your oral testimony it indicates that the FBI does not certify or
approve other organizations' instructions including firearms train-
ing. Has the FBI ever actually observed VA's firearms training or
instruction?
Mr. WOLFINGER. Last year there was some dialogue between our
firearms training unit and the VA over their training and we con-
sulted with them and looked over their outlines and materials. I do
not believe that there was any actual on-the-scene observation of
their training.
Mr. EVERETT. If asked, would you make an observation?
Mr. WOLFINGER. We certainly have tried to work with the other
federal agencies and local agencies over law-enforcement issues.
Certainly. We'd be happy to work with them. We really should not
be put in a position though of certifying it or approving it. The fire-
arms training really should be dependent on the nature of the job
that the officer is asked to do, and our job is considerably different
than the uniformed police officer in the VA.
Mr. EVERETT. Do you know if any other federal law-enforcement
entity that conducts firearms training?
Mr. WOLFINGER. We do, I know that FLETC does: Conressman,
we have uniformed police at the academy and we sen them to
FLETC, to the Federal Law Enforcement Training Center, in
Glynco for their initial training because the nature of being a uni-
formed police type person in the FBI is different than being an FBI
agent.
Mr. EVERETT. I assume your answer is then that you do not
know of any other government agency.
Mr. WOLFINGER. No. I'm sorry.
Mr. EVERETT. Mr. Rinkevich, I would like to highlight actually
some of your testimony that you've given and then I'll follow it with
a question. You point out that yours is the largest, most cost-effi-
cient center for law-enforcement training in the nation; that cur-
rently 70 federal agencies participate in more than 200 different
programs at the center; that consolidated training avoids duplica-
tion and overhead costs that would be incurred by operating mul-
tiple agencies at different training sites; and that it is estimated
that the government would save almost $110 million in per diem
costs in fiscal year 1998. And you point out that a single agency
cannot afford the sophisticated facilities and staff which are re-
 33
quired for the state-of-the-art training necessary to adequately pre-
pare our nation's law-enforcement personnel. You also point out it
would cost approximately $175 million to duplicate what you've got
there. My question is, could the FLETC offer VA specialized train-
ing that they have testified here today that they need.
Mr. RINKEVICH. Mr. Chairman, are you referring to the kind of
training that is peculiar to the Veterans' Administration police?
Mr. EVERE'IT. Yes.
Mr. RINKEVICH. It is a common method of operation at our center
at FLETC to accommodate that kind of agency-specific training. If
I could take just a minute and explain to you, the program that the
FBI police participate in is our 8-week basic police training pro-
gram. In addition to the FBI police we have the uniformed division
of the Secret Service, we have the United States Capitol Police.
Your own police force here participates in that program. The De-
fense Protective Foree, those folks that protect the uniformed folks
that protect the Pentagon. The folks that protect the CIA and the
National Security Agency. They all participate in that program.
The way the center works is that we provide the basic training
skills that any of those police officers need to have in order Ito per-
form the duties of a uniformed police officer. It is then up to each
individual agency to take those students after we've given them the
basic skills, if you will, the undergraduate work, and give them the
agency-specific skills and knowledge that they need to have, and
most agencies do that. It takes a special training session for the
Capitol Police for example to understand the particular laws and
the way in which they perform their functions at the United States
Capitol.
The uniformed division of the Secret Service does a special fol-
low-on agency-specific training to deal with the specific mission,
the specific authority, the specific policies of the uniform division.
So, the answer to your question is yes. The system is designed that
way, and it is used that way by most of the agencies; basic training
by the center at Glynco and that agency-specific training by the
agency instructors perhaps with assistance from our own instruc-
tions, but nonetheless agency-specific training.
Mr. EVERE'IT. Well, thank you very much, and I want to thank
you gentlemen for your testimony here today, and at this point
we'll call the next panel. I'm sorry. I did not recognize that Dr.
Snyder had returned to the room. I was kind of listening to the tes-
timony, and I do apologize, Dr. Snyder.
Mr. SNYDER. Well, I've been sneaking in and out, Mr. Chairman,
running back and forth. I appreciate your--
Mr. EVERE'IT. And I did not mean to dismiss-you'll get an op-
portunity.
Mr. SNYDER. Just really one question, Mr. Rinkevich. I'm a big
fan of well-trained law enforcement and I think that that's been
lacking in our nation. I think most of us have figured out that that
has been a gap, and frankly I think one of the reasons that crime
rates have come down is States and local communities have really
put a lot of money into good training for police officers. So, if you
ever need any help from anything I can do for you, I would be a
fan of that.
 34
But I do want to quibble at little bit about your fairly broad
statement about consolidation, and if I can, just the only question
I want to ask, on page 2 of your statement you say, ''Using a multi-
disciplined faculty that includes criminal investigators, lawyers,
auditors, researchers, education specialists, police and physical se-
curity professionals," you provide entry-level and basic law enforce-
ment. But there's nobody in there remotely related to medical, and
probably some of the most painful episodes for communities is
when law enforcement ends up killing a schizophrenic. Very dif-
ficult situations. Or somebody who's on drugs and when they're
dried out they're just fine. I mean, you know those terrible things
that you all try to prepare people for. But isn't it a fair statement
to say if I'm the VA people trying to make a decision about where
to get my training and I read materials like this that doesn't even
mention the word medical, is it not reasonable for them to think
since we want our folks to be focused on our patients and the folks
roaming through the campus there and the patients that come and
go and the drugs addicts that will show back up in the middle of
the night saying I need back in that, I mean, wouldn't this be a
little bit of a flare for them when you all don't put any emphasis
on medical? Now, I know that you provide medical trainin~. I
mean, I bet you do. I'd be shocked if you didn't. But this certamly
tells me that your focus is not on it at all.
Mr. RINKEVICH. Well, it's quite true, Mr. Snyder, that we don't
have a focus in the sort of specific area that the Veterans' Adminis-
tration police would need it on dealing with the law-enforcement
responsibility in a medical environment, and the reason for that is
we don't train any police that guard medical facilities or are re-
sponsible for medical facilities.
Our system is designed so that our campus houses the agency
personnel from the agencies that we train so that they can then
take the student after they've been given the basic skills and give
them what they need to know to be a Secret Service Agent or an
FBI police officer. The Veterans' Administration could house at our
campus its personnel that would be needed in order to provide that
agency-specific training, and if they needed medical personnel or
other folks that were imbued with the culture of the Veterans' Ad-
ministration and a hospital system, that would be the way in which
to accomplish it.
We of course do provide medical training. We have extensive
training in trauma management. We have extensive training in
dealing with behavioral issues, disoriented people and mental cases
and that sort of thing because other police officers confront those
things on a regular basis on the street as well.
Mr. SNYDER. Right. And I knew you did, but I'm just saying you
chose not to focus on that in your statement here. With regard to
your comment about they could house those personnel, but the sit-
uation now is they get on the phone and say Dr. Jones, are you free
tomorrow afternoon? We've changed our schedule. Dr. Jones is a
psychiatrist who's working-I just made up Dr. Jones-can you
stroll over here this afternoon? We need to change the date of that
simulation. We need our schizophrenia lecture moved up. I mean,
they're using medical people from a VA facility. It's right on the
same grounds, it's on the back half of the campus, and I mean,
 35
they think they've got a pretty nice situation right now. They can
pull their nurses and do simulations and not having to fly in fac-
ulty and house them somewhere. They see that as part of their re-
sponsibility as a VA employee. But anyway, I appreciate your com-
ments and I know everybody here is trying to do a good-faith job
of good training in law enforcement in the most cost-effective way.
Thank you, Mr. Chairman.
Mr. RINKEVICH. If I could, Mr. Chairman, just one quick com-
ment, Mr. Snyder, and that is that our other agencies confront that
same inconvenience. In other words, when the Secret Service needs
to have someone come in that is posted here in headquarters in
Washington, DC because of a special skill area, they make arrange-
ments for that. So, it does work. You're right, it's much more con-
venient if it's right across the street on the same campus, but it
is possible for those arrangements to be made.
Mr. EVERETT. Thank you, Dr. Snyder, and my apologies once
again. I might point out to this panel and the other panel that all
members of this Committee Wlth the exception of our ranking
member are members of the National Security Committee also.
And you can appreciate the fact that the Chairman himself would
probably be going back and forth if he were not Chairman. So,
thank you for rejoining us, and we all recognize the fact that QDR
is one of the .most important things that we're doing this year as
far as national security is concerned and that's the reason that the
members are there.
Again, I thank this Committee and I now call the next Commit-
tee. Mr. John Vitikacs of the American Legion, and Mrs. Barbara
Zicafoose of the Nurses Organization of Veterans' Affairs, Mr. Er-
nest Little, a fire fighter at Perry Point, Maryland, Veterans' M-
fairs Medical Center, who will be representing AFGE. And I'll point
out the National Association of Government Employees will also
submit a statement for the record.
[The statement of National Association of Government Employ-
ees appears on p. 90.]
Mr. EVERETT. We have tons of paper up here and I'm trying to
get them all together. And at this point I'd recognize John Vitikacs
to go ahead and if you will make your statement. Again, I ask all
panel members to keep statements at 5 minutes, and your complete
statements will be made a part of the record. Thank you.
STATEMENTS OF JOHN VITIKACS, ASSISTANT DIRECTOR, NA-
TIONAL VETERANS AFFAIRS AND REHABILITATION COMMIS-
SION, AMERICAN LEGION; BARBARA FRANGO ZICAFOOSE,
MSN, RNCS, ANP, LEGISLATIVE CO-CHAIR, NURSES ORGANI-
ZATION OF VETERANS AFFAIRS; ERNEST W. LITTLE, FIRE-
FIGHTER, PERRY POINT VETERANS AFFAIRS MEDICAL CEN-
TER; ACCOMPANIED BY SANDRA CHOATE, ASSISTANT GEN-
ERAL COUNSEL, AMERICAN FEDERATION OF GOVERNMENT
EMPLOYEES
STATEMENT OF JOHN VITIKACS
Mr. VITIKACS. Thank you, Mr. Chairman, Dr. Snyder, members
of the subcommittee. Thank you for inviting the American Legion
to testify on safety concerns within the Department of Veterans M-
 36
fairs. I will limit my remarks to the issue of arming VA security
officers.
First of all, I would like to commend Mr. John Baffa and Mr. Bill
Harper for the professionalism, competence and expertise they
have provided the VA Security Service over the past several years.
Mr. Chairman, over the past 13 years the American Legion testi-
fied on two previous occaSIons concerning arming VA security offi-
cers. On both occasions for a combination of reasons the American
Legion did not support armed VA security officers. Today the
American Legion is more flexible on this matter. As stated in our
prepared testimony, the American Legion supports completing the
VA Security Service pilot program on arming security officers and
fully evaluating the program prior to deciding the future of this im-
portant subject.
Mr. Chairman, the world today is a much more dangerous place
than it was 13 years ago. Crime in the inner cities has increased,
and that is where a majority of VA medical centers are located.
There is strong testimony on the pros and cons of arming VA secu-
rity officers. However, adequate documentation on the objectiveness
of each position is absent. The pilot program currently underway
can help answer many questions.
The American Legion believes that training, supervision and
quality of individuals recruited by VA Security Service has im-
proved in recent years. This is due to competent leadership and im-
proved pay and performance standards. Mr. Chairman, there are
many factors to consider in the ultimate recommendation VA
makes on arming security officers.
In the final analysis, VA medical centers and regional offices
must be safe and secure for patients, staff and visitors. Recent
tragic events throughout the country and within VA have left all
of us shocked and uncertain about our own safety and security. It
is with this conviction that the American Legion looks forward to
reviewing the results of the pilot program now underway prior to
developing an official position on this issue. Mr. Chairman, that
completes my statement. '
[The prepared statement of Mr. Vitikacs ap~ars on p. 57.]
Mr. EVERETT. Thank you very much. I will now recognize Ms.
Zicafoose for your statement.
STATEMENT OF BARBARA ZICAFOOSE
Ms. ZICAFOOSE. Mr. Chairman and members of the subcommit-
tee, I am Barbara Zicafoose, a nurse practitioner in the Center for
Outpatient Services at the Veterans' Affairs Medical Center in
Salem, VA. As Legislative Co-Chair for the Nurses' Organization of
Veterans' Affairs, I am pleased to present testimony on safety and
security in the Department of Veterans Affairs on behalf of NOVA.
I speak for our own membership and for the more than 40,000 pro-
fessional nurses employed by the DVA.
NOVA is a professional organization whose mission is shaping
and influencing the professional nursing practice within the DVA
health-care system. We are very much interested in assuring that
the VA is a safe, secure place for patients, employees and visitors.
Work llace violence has emerged as a critical safety and health
hazar nationally.
 37
The magnitude of the problem is well documented in the' lit-
erature. The statistics account not only for the actual deaths tha't
occur, but for an additional innocent bystanders and nonemployees
killed yearly. The Bureau of Justice Statistics in a report in 1994
reported that 1 million individuals are victims of some form of vio-
lence in the work place each year. Health-care providers are at an
increased risk for violence because they are caring for individuals
and families during a time of illness which can precipitate stress
and the sense of loss of control leading to inappropriate or violent
behavior. One study found that nursing staff at a psychiatric hos-
pital sustained 16 assaults per 1QO employee per year. Therefore,
it is timely that this Subcommittee and the DVA investigate work
place safety.
NOVA recognizes that the most frequent recommendation for
controlling violence at our medical centers is to arm our VA police
with guns. We support Secretary Jesse Brown and the DVA's reluc-
tance to place firearms in our hospitals. The very presence of a
weapon in a work environment for whatever reason can contribute
to a triggering event for violence. Many of our veterans suffer long-
term complications, disabilities and/or emotional trauma related to
these weapons. Guns are for killing and have no place in institu-
tions developed to promote health and wellness and the treatment
of disease.
NOVA supports an alternative strategy. We recommend staff
education and training along with knowledge of evaluation and
intervention techniques to reduce work place violence. One problem
with the successful use of staff education and trainin~ as a success-
ful intervention method is a lack of awareness, and m many cases
a belief system that denies the very possibility that violence does
exist in our DVA environment. However, experts agree that the
best approach to reducing work place violence is prevention and
protection.
The Occupational Safety and Health Administration in 1996 pub-
lished a voluntary generic safety and health program management
guidelines for all employers to use as a foundation for their safety
and health pro~ams which includes work place violence prevention
program. The hterature supports this belief that education and pre-
vention for work place violence would be the first intervention. Re-
curring prevention themes include staff education and training,
tighter security methods, adopting a zero-tolerance policy toward
unacceptable behavior, developing a crisis management team which
could evaluate any warnings and decide what to do about them,
and the creation of a trauma team.
One intervention in particular, tighter security measures, is criti-
cal for the DVA because of the location of some of our medical cen-
ters in high-crime areas, and the growing implementation of sat-
ellite and mobile clinics. Some physical security measures rec-
ommended in the literature which we feel would be very beneficial
to our facilities include increased security of personnel on the
premises, improved lighting, beepers for human resources and se-
curity personnel, bulletproof glass especially ' in our E.R.'s and our
high-profile areas, hidden panic buttons, closed-circuit television
cameras to monitor common areas where outbreaks of violence
occur, metal detectors in high-crime areas, and badges for all visi-
 38
tors. The use of frrearms was not included in the literature that
recommended improvement in tighter security measures.
Another invention is the adoption of a zero-tolerance policy to-
ward unacceptable behavior. NOVA applauds Secretary Brown on
his recent comments in putting veterans first where he addresses
in the work place and reports that violence, threats, harassment,
intimidation and other disruptive behavior in our work place will
not be tolerated. Work place violence is not limited to homicide, but
to those behaviors identified by Secretary Brown.
A third intervention is the creation of a crisis management team.
This team would be made up of the Director, a psychologist with
special training in this area, the head of security, and legal counsel
for special training. The team would have a written plan to be fol-
lowed when a crisis occurs or there are signs of a crisis; would
evaluate the warnings and decide what actions would be taken.
And then a potential life saver in work place violence that the
literature strongly supports and one most often overlooked is devel-
opment of a trauma team. This team would be assigned specific
jobs such as first aid, media control, management of onlookers and
notification of families.
Work place violence is a problem of epidemic proportions. It can
include violent, threatening, harassing, intimidating and disruptive
behaviors. The literature supports that there are tactics for evalu-
ating and diffusing work place violence issues without the use of
weapons. Staff education and training along with knowledge of
evaluation and intervention techniques can substantially reduce
the possibility of work place violence.Initiating prevention and
intervention techniques as identified can make the work place safer
by stopping a crisis before it begins.
I would like to thank NOVA's president, Dr. Maura Miller and
legislative co-chair, Dr. Sarah Myers for their assistance in the
preparation of this testimony.
Mr. Chairman and Subcommittee members, thank you for the op-
portunity of presenting this testimony on behalf of NOVA.
[The prepared statement of Ms. Zicafoose appears ,on p. 61.]
Mr. EVERETT. Thank you. Mr. Little.
STATEMENT OF ERNEST LITTLE
Mr. LITTLE. Good morning, Mr. Chairman. Mr. Chairman and
members of the subcommittee, my name is Ernest Little. I'm a fire
fighter employed by Department of Veterans Affairs Medical Cen-
ter at Perry Point, Maryland. I'm here today on behalf of the Amer-
ican Federation of Government Employees, and particularly for
AFGE's federal fire fighter members.
AFGE represents 21 out of 31 Veterans' Affairs fire departments.
With me is Sandra Choate. She is Assistant General Counsel and
staff person for AFGE responsible for fire fighter issues. I might
also add that AFGE works closely with the five major organizations
representing federal fire fighters all of whom concur with our testi-
mony.
I'm particularly pleased to have this opportunity to appear before
you and share our concerns over the fire protection afforded to our
nation's veterans and the employees of the Veterans' Affairs Medi-
cal Centers.
 39
Today 111 focus on two main points. First, millions of dollars in
savings would be achieved if the Department of Veterans Affa:l.:s
would emulate fire services around the country and take advantage
of the full range of emer~ency services of which fire fighters are
uniquely qualified to proVlde. Secondly, at the present time, veter-
ans who are patients at medical centers as well as employees are
at great risk at most facilities because of the VA's inattention to
its fire services.
With regard to the first point, missed opportunities, we believe
the Department of Veterans Affairs would emulate fire services
around the country and take advantage of a full range of emer-
~ency services which fire fighters are uniquely qualified to provide,
It could save millions of dollars and provide a needed and nec-
essary service to the veterans of this country and to the Veterans'
Affairs employees.
There is already a shining example of this within the system.
AFGE Local 1119, the Montrose VA in New York, submitted a pro-
posal last December to take over the emergency medical services
functions. The director agreed and the existing ambulance service
contract estimated to cost between $260,000 and $270,000 annual
was canceled. An ambulance was purchased for $75,000 and the
fire fighters took over the ambulance EMT service. There's no in-
crease in staff and they are certified as emergency medical techni-
cians. That justified a grade increase which cost to the VA was
about $95,000. Response time from the fire department under 4
minutes as contrasted with the half hour to 2 hours for the contrac-
tor. In summary-EMS functions at Montrose will save approxi-
mately $200,000 after the first year, will provide a much higher
quality of service.
At the same time, it was a job easily assumed by employees al-
ready trained to respond. This same proposal including providing
EMS service to adjacent federal buildings on a reimbursable basis
was submitted by IAFF Local in Minneapolis. The director con-
cluded he was not interested. In fact, he has indicated that he is
not interested in keeping fire departments. He simply wants to out-
source regardless of the impact on veterans or the cost.
AFGE's written testimony provides a background for a second
point with references to the science of fire suppression. It is impor-
tant to understand the several factors when analyzing the need for
fire service. Sprinkler in the buildings reduce the fire loss but not
the fire risk at most VA facilities that are not fully sprinkled any-
way.Further, when there is a fire today even in a sprinkler build-
ing, the high use of plastics and other materials, particularly at
medical center facilities, result in extremely hot, fast-burning fires
which produce an increased amount of toxins and smoke. Let me
add, Mr. Chairman, sprinkler systems normally don't put out a
fire. They're designed to keep a fire in check. Why would the VA
grant a waiver to staffing levels if the facility is sprinklered? The
highest injury and death rate occurs from smoke inhalation, and
the most vulnerable are people who are unable to evacuate build-
ings such as the type of VA patient population. The elderly, sick,
or those who are easily confused such as the mentally ill, the men-
tally retarded and those suffering from Alzheimer's or who have
damage from substance abuse.
 40
Both fire suppression and emergency services should always be
discussed in terms of response times. It is well known how long it
takes before a fire results in total loss. The National Fire Protec-
tion Association has produced a film which shows 40 seconds by
the dropping of a lighted cigarette between two sofa cushions. The
cushions will begin to smolder and give off toxic fumes and flam-
mable vapors. Within 5 minutes there is total flash-over resulting
in heat so hot it becomes impossible to enter the room which is
roughly around 1,100 degrees.
Within 10 minutes the room is totally filled with vapors creating
the back-draft condition that results in a total loss. Thus, it is criti-
cal that a response can be made well within the 10-minute limit.
Mr. Chairman, when critical response times cannot be met, the VA
must take needed action to ensure that the veterans and employees
are protected adequately by meeting minimum staffing standards
without the wide-spread use of temporaries which has been preva-
lent through the VA over the last 4 years. Further, that dual-
hatting should not be practiced where it provides inherent conflict
such as the dual-hatting police and fire fighter proposal being con-
sidered by Battle Creek, the protective services concept.
In addition, the Montrose VA example should be given serious
consideration as an appropriate adjunct to services offered by the
fire department. AFGE would welcome the opportunity to work
with the Committee and explore ways in which the Department of
Veterans Affairs fire and emergency services and provide all the
Department of Veterans Affairs facilities in the most efficient and
effective manner guaranteeing quality service for its customers and
our nation's veterans at the most realistic cost. Again, we thank
you for the opportunity to appear today and we'd be happy to re-
spond to any questions you might have.
[The prepared statement of Mr. Little, with attachments, appears
on p. 65.]
Mr. EVERETT. Thank you very much, and I assure you we'll make
sure all your complete testimony is entered into the record. We
have a situation here. I do not have a lot of questions for this
panel. I don't know that the other members will have some I'm
sure. But we have a vote going on and we can either try to get
through in a hurry and not have to come back. My ranking mem-
ber agrees that we should do it in a hurry. Let me just very briefly,
and if you would keep your responses brief I would appreciate it
because I know you don't want to be around here another hour. Ms.
Zicafoose, your testimony clearly indicates that NOVA's position in
opposition to arming VA police. Briefly can you tell me if there's
any situation where a local high-crime rate would justify arming
VA police?
Ms. ZICAFOOSE. I think what we would have to do is really look
at what's in place already and if there are other measures that
have been taken previously that could potentially have steps that
wouldn't require the use of firearms. I'm not saying that they
wouldn't be necessary, but I think we need to look at what's in
place to see if they have gone through every other recommended
method of reducing violence before that we put the guns in play.
Mr. EVERETT. Thank you. Mr. Little, we are going to ask VA to
respond to specific concerns you raised in your written testimony
 41
about VA's fire protection at particular facilities, and I can assure
you that we'll do that. I'll ask Mr. Clyburn now if he has any
questions.
Mr. CLYBURN. Thank you, Mr. Chairman. I apologize for having
to be out of the room.
Mr. EVERETT. I rerfectly understand.
Mr . CLYBURN. do have one question I would like to ask. I'm
thinking about your remarks this morning, Mr. Chairman, and the
figures laid out about the tremendous drop in incidents that we've
had. And we all know by reading all the reports that crime is de-
creasing in our society. However, you can't tell it by watching TV
and reading the newspapers. We all know what sells newspapers,
gruesome headlines and the lead story on the news every evening
is going to be about some crime because that's what seems to
arouse people and get numbers up. But the actual incident num-
bers are dropping. In view of that, I would like to know, and I
think historically the American Legion has been sort of against
arming the Veterans' Police. You seem now to have changed that
position. Why?
Mr. VITlKACS. On previous occasions when this organization tes-
tified on this subject was 1984 and 1989, over the past 13 years.
At that time both of the hearings were oversight. There wasn't any
discussion at that time about a pilot program. As I believe, the
issue was will we or will we not do this, and I think that we were
opposed to unilaterally arming VA security officers without having
adequate systems in place to assure that the training, the super-
vision, the quality of the individuals recruited on the police forces.
We weren't certain at that time that all of the criteria that we
would have liked to have seen in place was in fact in place. I think
that this issue has certainly improved in the past half-dozen years
and the number of violent incidents have increased. And we
haven't done a 180-degree change in our views, we've done a 90-
degree change, and that is we support the pilot program and that's
as far as we've gone in changing our position on that subject.
Mr. EVERETT. Dr. Snyder? '
Mr. SNYDER. Is it Zicafoose?
Ms. ZICAFOOSE. That's right.
Mr. SNYDER. I liked your statement. I think I agree with about
everything that was in it. But, you know, I live five blocks from a
VA hospital in Little Rock and we're just coming from different per-
spectives I think. Even though I trained in one I'm too old now to
have recollections of that. You're coming from the perspective of
what's going on inside the hospital and I seethe parking lot as an
extension of my neighborhood and the security and safety factors
out there, and it's my neighborhood so I know that we have had
some occasional problems with houses on the edges of the parking
lot and so on. So, it may be that the VA can draw the line at the
door or something. I think we all agree if you have a lengthy walk,
bus trip, from the parking lot that that's a different situation than
what you're concerned about inside the work place environment.
But I thought it was interesting when you were talking, I thought,
wait a minute, she's talking about inside and I was thinking in my
mind the parking lot outside. That's not really a question, but
you're welcome but you're welcome to comment any way you like.
 42
Ms. ZICAFOOSE. That is a very good point, and I think the thing
that we really have to be careful of is how we determine where
these guns are going to go, in what facilities, and when they're
being used because if you look at the statistics, in 1994 Labor re-
ports that there were 1,071 work place deaths, but when you look
at the number of actual deaths within the DVA, we probably don't
make up 1 percent of that. So, does that really justify putting guns,
and how do we limit where those guns are put when?
Mr. EVERETT. Thank you, and I want to thank all the panel
members and the members for their participation today. I want to
conclude the hearing with a couple of observations. First, we all
recognize that this is a much different world than most of us grew
up in. Now, all of us gentlemen are much older than you ladies
here, but the world has changed. It is a more dangerous place.
Having said that, however, let me say that we've heard serious
questions about arming of VA police. I do not think at this point
we are persuaded arming is prudent or necessary. The subcommit-
tee will continue to review the progress of this pilot program. We'll
hold another hearing at its conclusion. Second, how the VA trains
its police warrants further examination in my opinion. I do not un-
derstand why the VA has its own training program when the
FLETC and the FBI do the same training on a much larger scale
and with probably a greater savings to the taxpayers. Finally, I
would be most interested to see the VA's response for the record
on the adequacy of fire protection at particular VA facilities. Safety
must come first. All members will have 5 legislative days to submit
questions for the record. The hearing is adjourned.
[Whereupon, at 11:55 a.m., the subcommittee was adjourned.]
 APPENDIX

PREPARED STATEMENT OF CONGRESSMAN CLYBURN

As the ranking democratic member of this subcommittee, I am pleased to join
Chairman Everett in holding this very important hearing.
I know that the safety and security of our VA hospitals is of the utmost impor-
tance to the VA and to the members of this committee. In my view, we would not
be accomplishing our mission of providing the highest possible health care service
to our veterans if we were unable to protect the safety and integrity of our VA hos-
pitals.
I am greatly interested in hearing testimony from the VA on its pilot project to
arm VA police officers at certain VA horpitals. I am aware that the tragic shooting
of a doctor in Jackson, MS earlier this year has caused renewed concern over the
adequacy of the safety and security of our VA hospitals.
I must say, however, that i believe the VA ought to be taking a measured ap-
proach when it comes to making any final decision to arm its police officers. Very
few private hospitals, even in some of the most dangerous, crime-ridden areas of our
country, allow the officers who guard their facilities to carry guns. I believe there
is a reason for this.
As the written testimony of the nurses association suggests, hospitals are for
making sick people healthy; guns are for killing people. The VA should be extremely
cautious in its approach to this issue. There should be an extensive, well thought-
out, hospital-by-hospital analysis of the feasibility and propriety of arming VA offi-
cers before jumping into such a course of action.
To my mind at least, it is just as easy to imagine a situation where a VA officer
accidently kills or seriously injures somebody during the course of his duties as it
is to imagine a situation where the officer's gun keeps a killing or serious injury
from occuring.
I welcome the opportunity to hear testimony on this extremely sensitive issue, as
well as the chance to get an update on the status of VA fire departments and the
VA's accountability of controlled substances. '
Thank you again, Terry, for working with us to put together such a timely and
important hearing.

PREPARED STATEMENT OF CONGRESSMAN EVANS

Mr. Chairman, I want to thank you and Mr. Clyburn for calling this extremely
important hearing today. As you know, the VA is right in the middle of its pilot
program to arm VA police officers at selected hospitals across the country. There
could be no more appropriate time to conduct diligent oversight of this program.
I share this subcommittee's concern over the recent violent episode at the Jack-
son, Mississippi VA hospital in which a VA doctor was killed by an angry patient.
I am also deeply troubled by the deaths of four VA police officers in the last five
years.
There should be no more important priority than to ensure the safety and security
of hospital patients and law enforcement personnel at VA facilities. We should close-
ly consider the means by which we can best accomplish this mission. I look forward
to hearing testimony this morning concerning the pilot program to arm VA police,
as well as other safety and security issues relating to VA fire departments and the
security of prescription drugs at VA pharmacies.
Thank you again Terry and Jim for taking a closer look at these vital issues.

(43)
 44
STATEMENT OF JOSEPH R. WOLFINGER, AsSISTANT DIRECTOR,
FEDERAL BUREAU OF INVESTIGATION
Good morning Mr. Chairman and members of the committee, I am Joseph R.
Wolfinger, Assistant Director of Training for the FBI. I understand that I am here
today to provide this committee with information about FBI Trainina and specifi-
cally our Firearms Training Program. The FBI's New Agents Training program is
a 16 week course of instruction focusing on four core areas: academics, physical
training, practical applicationl and firearms training. This equates to approximately
654 hours of instruction of wnich firearms training accounts for approXImately 116
hours divided by 28 sessions. I think it is important to note, that in general, the
mission of Special Agents of the FBI is different than that of a federal police officer,
and therefore, our training -is different. Agents are generally not "first responders"
and do not routinely "patrol". Likewise, our basic qualifications and the selection
process are different from other law enforcement organizations.
A Special Agent's training does not stop at the conclusion of the New Agents
training. After reporting to their first office of assignment, the Special Agent begins
a two year probationary JiWlriod, during which the new Special Agent receives on-
the-job training from seDlor Special Agents. Durinjt this period, the new S~ial
Agent is expected to perform specific functions of his/her job, to include testitying,
writin~ affidavits, and so on, and is evaluated on performance. If for any reason the
probationary Agent is dismissed, there is no appeal. Additionally, all Special Agents
are required to qualify four times a year with their issued weapons and the weapons
they have subsequently been authorized to carry.
I would also like to clarify that the FBI does not "certify" or "approve" other orga-
nizations' instruction, to include firearms training. We have, in tlie past, offered and
provided FBI instructor training to personnel from other organizations. Having said
that, I would like to provide you with an overview of our New Agent Firearms
Training curriculum. . .
The primary mission of the Firearms Trainine Unit (FTU) is to train new Agents
to become safe and competent shooters with Bureau-issue handguns, shotguns, and
carbines through a 16 week, three tiered training program consistine of:
(1) fundamental marksmanshil, trainina with all three weapon systems;
(2) combat/survival shooting incorporating all three weapon systems on progres-
sively complex and challenging courses, and;
(3) judgmental shooting.
The FTU also administers firearms related training programs for Agents assigned
to FBIHQ, the Bureau's 56 field offices, and the law enforcement community. These
programs are supported by ongoing research, and the testing and procurement of
weapons, ammunition, and related equipment appropriate to the needs of modem
law enforcement. The unit also maintains the FBI's arsenal of issued and approved
weaponry.
During firearms training, students will fire a total of 4,395 rounds. Nearly 3,000
rounds will be fired during the course of 19 sessions as students master basic
marksmanship skills and "qualifr" for the first of two required times with the hand-
gun, shotgun, and carbine. Dunng the remainine nine sessions, students will fire
approximately 1,400 rounds as their skills are challenged during combat/survival
training, and their prerarations for final qualification.
The combat/survlva portion of the firearms curriculum includes "judgmental"
training. Along with combat courses which include "no shoot" targets, and other
courses where students must work as teams to resolve complex shooting problems,
students are also e~sed to at least 12 com',uter driven scenarios with which they
must interact and, If appropriate, employ deadly force. Unsafe, unprofessional, or
inappropriate behavior dunng these scenarios or at any other time in firearms
training may result in a recommendation for a New Agent Review Board or outright
dismissal.
Student performance is assessed constantly during firearms training. When ap-
propriate, students are given individualized instruction. If a student shoudld fail to
qualify, they are given two weeks of intensive remedial training after which they
are afforded anotner I>pportunitr to qualify. Failure at this juncture results in dis-
missal from training. The TrainIng Division has not lost a student because of a fire-
arms related failure since 1990.
In addition to successful completion of their initial firearms training, all FBI
Agents are also required to attend firearms training and "qualify" four times per
year throughout their careers. A minimum of 1,000 roundslAgent/year is budgeted
for this purpose to ensure that Agents maintain this critical, but perishable skill.
Agents who fail to satisfy these minimum requirements lose their authority to carry
 45
firearms until the deficiency is resolved, and risk loss of availability pay should the
deficiencr persist. Because the loss of pay is such a strong incentive, this has not
been an ISsue.
As I said earlier, the New Agent firearms training curriculum consists of 116
hours of classroom and ranue instruction broken down into 28 sessions. These ses-
sions are very much intertrelated and complement training conducted by our Phys-
ical Training, Practical Applications, and Legal Instruction Units. So yes, our fire-
arms training is multi-dimensional, and is concerned not only with an A~ent's accu-
racy and proficiency with weapons, but also focuses on the relationship mherent to
having the power and authority of applying deadly force. It is an intense integrated
training program focusing on awareness, judgement, and skill.
 46

STATEMENT OF

JOHN H. BAFFA

DEPUTY ASSISTANT SECRETARY

OFFICE OF SECURITY AND LAW ENFORCEMENT

DEPARTMENT OF VETERAN AFFAIRS

BEFORE THE

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

OF THE

U.S. HOUSE OF REPRESENTATIVES

May 22,1997

Mr. Chairman and Members of the Subcommittee:

I am pleased to be here today to discuss issues related to safety and security at

VA facilities.

Police matters

The Office of Security and Law Enforcement was established in December 1989

to consolidate all of the Department's security and law enforcement functions under one

department-wide program. Responsibilities of the office include training VA police

officers" as well as establishing policy and providing oversight for police operations at

department medical centers.

Immediately following my appointment in 1989, I prepared a four-year strategic

plan outlining needed improvements and a time-line for their accomplishment. This

plan, which was approved by the Secretary in 1990, included goals of signifICantly

expanding and improving training for police officers at all levels. Also addressed in the

plan was expanding and improving program oversight and other goals designed to

er,sure improved local services. One of the areas that required careful attention was

how VA police officers would defend patients, employees, property and themselves.

Prior to 1971, VA maintained a "security guard" force. When we converted to

pOlice operations in 1971, a decision was made to equip our police officers only with a

chemical irritant projector, utilizing CN (Mace) as the active ingredient. Subsequently,

approximately 15 facilities were authorized to also equip their police offICers with the
 47

straight stick baton because of the limited effectiveness of Mace and because of

increa.singly violent encounters between police officers and intruders at those locations.

With these limited weapons at their disposal, VA police, at great personal risk,

performed admirably and dealt successfully with most violent encounters.

Several incidents drew much attention to the fact that VA police officers were at

a distinct disadvantage when faced with an armed individual --two separate incidents in

the late 1980s at Brecksville, Ohio and Bronx, NY, in which three unarmed VA police

officers were shot and killed in the line of duty, and in 1992 there was a serious

wounding by gunfire of another police officer at VAMC Columbia, SC.

Since becoming the Secretary of Veterans Affairs, Jesse Brown has played a

direct role in issues relating to security at VA facilities. In August 1995, after giving

serious consideration to the various and differing opinions on the matter, Secretary

Brown elected to initiate a one-year pilot project to arm police officers at no more than

six VA medical centers. The purpose of the pilot is to determine the feasibility of arming

officers at additional facilities. Section 904 of title 38, United States Code, authorizes

the Secretary to fumish Department police officers with such weapons as the Secretary

determines to be necessary and appropriate to ensure the maintenance of law and

order and protection of persons and property on Department property. Following thE!

preparation and staffing of a VA directive, and consultation with the Attomey General

and representatives of the FBI Academy, VA initiated the pilot program in September

1996. The Office of Security and Law Enforcement conducted on-site reviews and

firearms training at five pilot sites: Bronx, NY; Richmond , VA; North Chicago, IL;

Chicago (West Side) IL; and West Los Angeles, CA. These sites were selected

because of the support of local m'anagers and because of a desire to have as broad a

geographical representation as possible.

The five pilot sites initiated the program as they completed all the prerequisites,

with the first being North Chicago on September 30, 1996, and the last being Chicago

West Side on January 1, 1997. We originally intended to conduct an initial evaluation

of the program at the sixth month, but because of the shooting death of a physician at

VAMC Jackson, MS, the Secretary directed that a preliminary evaluation ~e provided to

him by April 1, 1997. The report of the evaluation, conducted by the Office of Security
 48

and L!lw Enforcement, judged the program to be successful to date. All actions taken

by officers were appropriate and therewas evidence that officers were exercising more

vigilance in the key areas of investigative stops and car stops. Comments from staff

and patients were overwhelmingly positive. Based upon this positive report, and in

order to develop a broader base of experience, the Secretary decided to expand the

number of facilities in the pilot program

The on-site firearm training program for the officers participating in the pilot was

developed with the assistance of the Chief of the FBI Academy Firearms Training Unit,

who reviewed the final training plan and concluded that our training exceeded or was

equivalent to that offered by most federal agencies. Also, at our request, the Chief of

the Academic Affairs Section at the FBI Academy reviewed our basic police officer

training course. Although this Section does not certify or accredit basic law

enforcement training, it was their conclusion in April 1996, that VA's 160-hour basic

course appeared to be consistent with the standards established at the Federal Law

Enforcement Training Center and at several state academies.

Title 38 authorizes the Secretary to prescribe the scope and duration of training

required for Department police officers. Immediately after my appointment, I focused

attention on improving both the quality and quantity of training given to VA police. At

that time there was a small, but dedicated, staff providing a basic police officer training

course of only 68 hours at the Little Rock VAMC. The Department of Justice had

recommended to VA that the training course be 160 hours. In August 1992, we

expanded the basic police officer course to 160 hours, added highly qualified instructors

in the important areas of law and human behavior, and greatly improved the classroom

facilities. In the basic course, we emphasize the specialized and specific needs of

policing in a health care environment and the participation of VA police officers as a

part of the medical care team.

VA's law enforcement training program is now funded through the Franchise

Fund and provides basic police officer training to police officers from the National

Gallery of Art, the Indian Health Services of the Oglala Sioux Indian Tribe, Pine Ridge,

SO, and Walter Reed Army Medical Center. These organizations have chosen our
 49

training center, in part, because of our focus on training our officers to deal with difficult

persons, utilizing the minimum amount of force necessary.

Finally, I wish to emphasize that we see the firearm as another tool for the

officer. We do not see that its addition, in any way, changes the philosophy that

Department officers use only the minimum amount of force necessary to de-escalate

violent encounters.

Controlled substances

Since the 1992 House Veterans' Affairs Committee hearing on controls over

addictive drugs and drug diversion, VA has made significant progress. Working with

the Office of the Inspector General, the General Accounting Office, and the Office of

Security and Law Enforcement, the Veterans Health Administration has instituted

regulations over the accountability of controlled substances that are more strict than

any state or any other health care system's requirements. Mr. Chairman, I would like to

briefly review some of the major actions taken by the Department to address the

diversion issue.

In 1991, the Secretary reported controls over lower scheduled drugs as a

material weakness under the Federal Managers' Financial Integrity Act report.

Subsequently, a series of actions were planned to correct the material weakness.

Resources were identified and approved for both the software development and the

necessary hardware to support the movement to requiring perpetual inventory of all

controlled substances. To improve accountability and automate manual processes,

three versions of controlled substances software have been released to VA medical

centers. Today all VA medical centers and clinics are required to maintain perpetual

inventory of all controlled substances dispensed. These requirements will result in

controls that exceed the community standards. In 1997, VA will recommend that the

material weakness be closed.

To deter and detect diversion, VA required that access to controlled substances

be limited within the pharmacy and that documentation be maintained regarding

employees who have that access. Storing and dispensing of controlled substances

must occur within locked areas and electronic access control devices must be installed

on all locations within pharmacy where controlled substances are stored or dispensed.
 50

This includes all cabinets, vaults, drawers, and carts where controlled substances are

stored or from which they are dispensed.

To verify the accuracy of inventories and identify any discrepancies in a timely

manner, verification of all controlled substances is required every 72 hours. Prior to this

requirement, inventory was verified monthly during the monthly narcotic inspection.

While this verification process is time consuming, automation has offset some of the

human resource requirements. There are examples where the 72-hour verification has

identified discrepancies, losses and thefts. These verifications continued to support

detection and deterrence of diversion.

To reduce the likelihood of diversion after an outpatient prescription is filled, a

tamper proof seal must be affixed to all controlled substance preSCription vials after

filling the prescription, all completed prescriptions must be stored in locked cabinets,

and positive patient identification and patient signature is required before the

medication is handed to the patient or hislher agent.

These are just some of the actions taken as part of a comprehensive plan to

improve the ability to deter and detect diversion of controlled substances within VA

facilities.

VA has also taken actions to improve the ability to deter and detect the diversion

of non-controlled substances from VA facilities. VA has implemented a "just-in-time"

inventory and delivery system utilizing private sector prime vendor distributors. This

distribution system has dramatically reduced inventories within VA pharmacies for both

controlled and non-controlled substances and has removed all inventories of

pharmaceuticals that were stored in VA medical center warehouses. VA has developed

and implemented Drug Accountability software that will assist VA medical centers in

verification of inventory. Requirements regarding verification of high cost

pharmaceuticals was established in 1991 and are still in effect. Additional software

development is ongoing. VA has established an interface with private sector prime

vendors that will allow for the automated downloading of goods received into VA

inventory. The software is undergoing testing and planned release is in the summer of

1997. After the software is released and implemented, VA will reassess current

inventory accountability requirements.

 51

VA currently operates six Consolidated Mail Outpatient Pharmacies (CMOPS).

These CMOPS dispense millions of prescriptions a year and maintain the largest

inventories of pharmaceuticals in the VA system. At all the CMOPS there is a

requirement that the private sector software allow VA managers to track and account

for their inventory, thereby automating the process and increasing their ability to deter

and detect diversion.

VA continues to review all reports of diversion received by VHA, Security and

Law Enforcement, and OIG investigations. While the temptation to divert both

controlled and non-controlled substances will always exist and individuals will continue

to attempt diversion, VA has substantially improved its ability to deter and detect

diversion. We will continue our efforts and work with all parties to identify opportunities

for improvements.

VA fire departments

At the vast majority of the Department's medical centers, fire fighting services

are provided by local community fire departments. When local fire fighting services do

not meet VA's minimum level of reqUirements, VA operates in-house fire departments.

The minimum level fire fighting services acceptable for VA medical centers is an initial

response from four paid firefighters and one fire fighting apparatus meeting the criteria

of .National Fire Protection Association Standard 1901 with a minimum pumping

capacity of 750 gallons per minute. This response must be available 24 hours a day,

seven days a week and must be capable of responding to the medieal center in eight

minutes or less, which is equal to a distance of approximately 3-1/2 miles.

Currently only 30 VA medical centers are operating in-house fire departments,

with approximately 387 FTEE. The total operating costs for all 30 fire departments for

FY 1996 was $16,289,215. The majority of these remaining 30 VA fire departments are

located at VA medical centers in rural areas served by small, all volunteer fire

departments. While many local communities depend upon volunteer fire departments,

such departments, by their nature, cannot guarantee VA's minimum level of response in

a given time.

Thirty years ago, more than 65 VA medical centers operated in-house fire

departments. As conditions have changed over the past several decades, local
 52

communities have expanded and their fire departments have grown in size and quality.

As the local fire fighting services expanded, fire fighting responsibility was trensferred

from VA medical centers to the local community whenever possible. In the past ten

years, 6 VA medical centers have closed their fire departments.

One of the objectives of the Under Secretary for Health's Prescription for Change

is to focus management attention on VHA's key business of providing health care. With

this in mind, we are exploring opportunities for contracting out fire fighting services

wherever possible. However, the potential for contracting out of fire fighting services at

VA medical centers in the future is limited. Because VA fire departments typically

perform a number of non-fire fighting duties. such as inspecting and maintaining fire

protection equipment, conducting fire drills, or serving as part of the hazardous

response team, in addition to providing fire fighting services at their medical centers, the

actual cost for their fire fighting services is significantly less than the cost to establish an

outside source for this service. This cost differential has been documented by the

numerous A-76 cost comparison studies.

VA policy is meant to ensure an adequate level of fire fighting .response for

buildings housing patients ovemight and reflects nationally-accepted practices. There

are no Federal laws or regulations or other fire codes or standards requiring VA to

establish, operate or maintain in-house fire departments.

A typical VA in-house fire department is staffed with 15 FTEE, including a fire

chief to provide a minimum of 4 fire fighters on duty for each tour df duty. VA maintains

a up-te-date fleet of fire pumpers with sufficient pumping capacity and equipment.

Each in-house VHA fire department has, as a minimum, a fire pumper that is less than

17 years old with the average age being 8 years old. VHA has a Fire Department

Program Manager who coordinates the activities of the VA fire department program.

While VA continues to pursue options which would enable us to focus on the

primary role of proving health care to our patients, the Department remains dedicated to

ensuring a safe environment for our patients, employees and visitors.

Vandalism at National Memorial Cemetery of the Pacific (NMCP)

In the late evening of April 19 and early moming of April 20, 1997, the National

Memorial Cemetery of the Pacific, or "The Punchbowl," was one of seven cemeteries in
 53

the State of Hawaii to be desecrated by vandals. Vandals spray painted profane and

racist words on all 22 walls in the Columbarium Courts and desecrated the Chapel,

grave mari<ers, railings and walls throughout the cemetery. Neither the Federal

Govemment nor VA appeared to be specific targets of the vandals as the unauthorized

ent~ by an unknown number of persons affected VA, State and private cemeteries.

The attack on NMCP, the Kaneohe State Veterans Cemetery and several private

cemeteries on Oahu was organized, as vandals used stencils and red spray paint to
publicize .their racist and hateful messages. The cost of repairs at NMCP was

estimated at $20,000, donated by the Paralyzed Veterans of America. I am pleased to

report that the damaged areas in NMCP have been restored and all graffiti has been

removed. Federal, state and local law enforcement officials continue to work together

and are still seeking the suspects.

Mr. Chairman, this concludes my prepared statement. My colleagues and I will

be happy to answer any questions.

 54

Statement of Charles F. Rinkevich

Director of tile Federal Law Enforcement Training Center
For Presentation to the Committee on Veterans Affairs
Subcommittee on Oversight and Investigations

Mr. Chairman and Members of the Subcommittee, I am pleased to be here today to

provide you with an overview on the operations of the Federal Law Enforcement Training
Center (FLETC).

Conceived as part of the great urban and police refonns of the \960s, the FLETC opened
its doors in 1970. Its headquarters have been housed since 1975 on a 1,500 acre former Navy
training base located just outside the city of Brunswick on Georgia's southeast coast .. The
FLETC also operates two satellite training facilities, an owned facility in Artesia, New Mexico,
and a licensed temporary facility in Charleston, South Carolina.

Born from the need to provide Federal law enforcement with consistent, high quality
training and nurtured through its infancy by a combination of interagency cooperation and
suppon, the FLETC has matured into the largest, most cost-efficient Center for law enforcement
training in the nation. Center facilities at Glynco include a modem cafeteria, regular and special
purpose classrooms, dormitories capable of housing more than 1,200 students (single
occupancy), office and warehouse space and state-of-the-art specialized facilities for physical,
driver/marine and firearms training. The Artesia satellite Center has facilities similar to those at
Glynco but on a much smaller scale.

The FLETC's mission is to conduct basic and advanced training for the majority of the
Federal Government's law enforcement personnel. We also provide training for state, local and
intemationallaw enforcement personnel in specialized areas and suppon the 'training provided
by our participating agencies that is specific to their needs. The Department of the Treasury has
been the lead agency for the United States Government in providing the administrative oversight
and day-to-day direction for the FLETC since its creation.

Using a multi-discipline faculty that includes criminal investigators, laWyers, auditors.

researchers, education specialists, police and physical security professionals. the FLETC
provides entry level programs in basic law enforcement for police officers and criminal
investigators along with advanced training programs in areas such as marine law enforcement.
anti-terrorism, financial and computer fraud, and white-coUar crime. Currently 70 Federal
agencies panicipate in more than 200 different programs at the Center.

During FY 1996 the FLETC trained 19,352 students, representing 88,792 student weeks
of training and had an average resident student population of 1,708. April 1996 projections by
 55

our participating agencies indicate that during FY 1997 the Center will train 29,351 students,
representing 135,691 student weeks of training, with an average resident student population of
2,609.

Both the Center and its worldoad have grown tremendously over the years as more
agencies have come to realize the many benefits of consolidated training. In 1975. when FLETC
relocated from Washington, D .C . a staffof39 employees moved with the Center. Today the
FLETC has an authorized staff of 5 12 permanent employees. Additionally, there are more than
150 per50lUlel detailed to the FLETC from its participating agencies. Several oCthe FLETC's
participating agencies also maintain offices at the Center with a total staff complement of over
600 employees and employees of the Center' s facility support contractors total more than 700.

In 1970 the FLETC graduated 848 students. By FY 1976, the first full year of training at
Glynco, that total had grown to 5. 152, and in FY 1996, as I mentioned earlier. the Center
graduated more than 19,000 students. The Center graduated more students in the last three years
than it did in its first 10 years of operations, a graphic example of the tremendous growth
experienced by the Center in the last few years. In all, the FLETC has graduated in exceSs of
325,000 students since its creation.

Training is conducted at either the main training center in Glynco, Georgia, our satellite
training center in Anesia, New Mexico, or the temporary training facility in Charleston, South

Carolina. The temporary training site in Charleston was established in FY 1996. to

accommodate an unprecedented increase in the demand for basic: training by the participating
agencies, particularly that of the Immigration and Naturalization Service (INS) and United States
Border Patrol (USBP). It is the direct result of recent Administration and Congressional
initiatives to control illegal immigration along the Uni~ed States borders and to protect Federal
workers in the workplace. We expect the Charleston temporary facility to IN! needed through
FY 1999. However, after FY 1999, sufficient capacity should exist at the Glynco and Anesia
Centers to lCCOII1InOdate the training requirements of all our participating agencies and the
Charleston faci1ity will be closed.

In addition to the training conducted on-site at one of the FLETC's residential facilities,
some advanced training, particularly that for state, local and intcmationa1law enforcement, is
exported to regional sites to make it more convenient and/or cost efficient for our customers.

Over the years, the FLETC has lNocome known as an organization that provides high
quality and cost cffic:icnt training with a "can do" attitude and state-of-the-art programs and
facilities. During my association with the Center, I have seen first-hand the many advantages of
consolidated training for Federal law enforcement personnel, not the least of which is an
enormous cost savings to the Government. Consolidated training avoids the dup1ication of
 56

overhead costS that wouIcI be incurred by the operation of multiple agency training sites.
Furthamore, we atimate that consolidated training will save the Government SI08, 100,000 in
per diem costs alone during FY 1998. This estimate is based onthe Center's projected FY 1998
workload and per diem rates in Washington and other major cities ofSl521day venus the cost of
housing, feeding, and agency misc:ellaneous per diem ofS25.26/day for a studem at Glynco.
Consolidation also ensures consistent, high quality training and fosters interagency cooperation
and camaraderie. Studems from the different agencies conuningle, thus learning about each
other and each other's professional responsibilities. The networks established at the Center last
throughout their careers.

We view FLETC and consolidated training as a National Performance Review concept

ahead of its time. Quality, standardized, cost-effective training in state-of-the-art facilities,
interagency cooperation, and networlcing are indisputable results of consolidation. . The
Administration and Congress can be proud of the quality of the training being provided at the
FLETC and the savings realized through consolidation

The FLETC is essentially a voluntary association with each agency's participation

governed by a Memorandum of Understanding; and bolstered by the conunitrnent of the
participating agencies, the Department of the Treasury and t~e Congress. Particularly in these
times of severe budget constraints, a single agency cannot afford the sophistiCated facilities and
staff which are required for the state-of-the-art training necessary to adequately prepare our
nation's law enforcement personnel. Only by consolidation at centnlized location are
programs and facilities like those at the FLETC economically feasible. We estimate that it
would cost in excess ofSI75,OOO,OOO just to duplicate the facilities available at the FLETC.

Mr. Chairman; in closing, I would like to emphasize that the Department of the Treasury
and FLETC management are strOng\y conunitted to providing high quality training at the lowest
possible cost. Substantial savings are being realized by the Government through the operation of
the Center as a consolidated training facility.

I am available to answer any questions you may have concerning this appropriation
request.
 57

STATEMENT OF JOHN R. VlTIKACS, ASSISTANT DIRECTOR

NAnONAL VETERANS AFFAIRS AND REHABn.ITAnON COMMISSION
TIlE AMERICAN LEGION
BEFORE TIlE
SUBCOMMITTEE ON OVERSIGHT AND INVESnGAnONS
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES HOUSE OF REPRESENTATIVES
ON
SAFElY AND SECURIlY IN TIlE DEPARTMENT OF VETERANS AFFAIRS

MAY 22, 1997

Mr. Chainnan and Members of the Subcommittee:

The American Legion appreciates this opportunity to present its views on the Security
Program of the Department of Veterans Affairs (VA) - Veterans Health Administration (VHA).

On May 19, 1988, The American Legion testified before this Subcommittee that
inadequate salaries and the lack of special salary rates contributed to high turnover and high
vacancy rates within VA Security Service. At that time, The American Legion opposed arming
VA security officers. Then, as now, the issues of training, supervision, pay and job performance
are important qualifying factors to arming VA security officers.

Over the past several years, a gradual improvement occurred in the recruitment and
retention of VA security officers. The security service vacancy and turnover rates dropped
considerably as a result of increasing most pay grades, along with the expansion of special pay
rates. Sadly, vacancy and personnel turnover rates have recently increased. However, this is due
more to the recent uncertainties about government reductions-in-force and other occupational
concerns.

The American Legion believes VA security officers should be paid commensurably with
the federal law enforcement pay scale. Adequate salaries and other benefits improve VA security
officer recruitment and retention. However, the question of whether to arm all VA police officers
is more important than simply receiving a larger paycheck. The recruitment and retention of a
competent security staff and providing proper police training and supervision creates the key
conditions for alleviating concerns about the arming of VA security personnel. A weapon does
not make a competent security officer; rather the officer must be able to diligently and
competently carry-out their responsibilities.

Mr. Chairman, VHA is in the process of conducting a test program of arming security
officers at six medical centers. The program will be completed about the end of 1997, with a full
evaluation in early 1998. At this time, the pilot program is too current for any substantial
assessment. The VA is learning valuable information in relation to the pilot program and The
American Legion supports the program.
 58

It is the conviction of The American Legion that VA medical centers and clinics are totally
responsible for the safety and security of patients and staff; protection of Government property;
the property of patients and staff; and the orderly conduct of affairs at VA installations. It is
equally important that VA employees be able to carry out their important duties and
responsibilities without the apprehension of worrying about their own safety and the safety of the
patients to whom they are providing care and services.

Recent tragic events at certain V A medical facilities support these concerns. Over the past
ten years, four V A security officers have died in the line-of-duty and others have been seriously
injured. Additionally, a medical doctor was recently killed at V AMC Jackson, MS; and a nurse
was raped at V AMC Manhattan, NY. Other serious incidents could have produced equally tragic
outcomes.

The American Legion recognizes that V A security officers face the same dangers as any
other city or county law enforcement officer, and often times more than other federal
departments. On an average day, VA security officers respond to assaults, disturbances, fleeing
suspects, motor vehicle stops, etc. Officers not only patrol buildings but also grounds and streets.
If V A ultimately makes a recommendation to permanently arm security officers, the
implementation of that decision should be gradual and measured, with close supervisory controls.

The V A Little Rock Training Academy must be capable of providing security officers
responsible training in the conduct and use of firearms. If a recommendation is made to arm VA
security officers it must be certain the best training is available, along with a continuous
instruction and assessment program.

Mr. Chairman, in all instances, a security officer's quick thinking and proper training
cannot neutralize someone intent on committing a violent crime. Thirteen years ago, The
American Legion testified before the House Veterans Affairs Committee that the potential
ramifications of V A security officers carrying firearms far outweighs its justification. The tragic
and nearly tragic events within VA facilities over the past ten years are very serious. The
American Legion believes the current pilot program on arming V A security officers should be
completed and fully evaluated prior to deciding the future policy of this important subject.

Mr. Chairman, that completes my statement.

 59

~n
_4_
...
Legion
For Go:! 'and Country
* WASHINGTON OFFICE '* 1608 "K" STREET. N.W . * WASHINGTON , D.C. 200062841 ..
(2021861 -7100 .. FAX (202) 861 -2128 ..

May 19, 1997

Honorable Terry Everett. Chainnan

Subcommittee on Oversight and Investigations
Committee on Veterans' Affairs
337 Cannon House Office Building
Washington, DC 20515

Dear Chainnan Everett:

The American Legion has not received any federal grants or contracts, during this year or in
the last two years, from any agency or program relevant to the subject of the May 22
hearing on Safety and Security in the Department of Veterans Affairs.

Sincerely,

John Vitikacs, Assistant Director

for Resource Development
National Veterans Affairs and
Rehabilitation Co~ssion
 60 .

JOHN R. VITIKACS
ASSISTANT DIRECTOR FOR RESOURCE DEVELOPMENT
NATIONAL VETERANS AFFAIRS AND
REHABILITATION COMMISSION

Mr. Vitikacs' service with The American Legion

commenced on November 1, 1982. He was assigned as a Field
Service Representative with the National Veterans Affairs
imd Rehabilitation commission . (VA'R). Assuming . . :' new
responsibilities in January 1990, John applied his Field
Service experience in the capacity of Resource Development
Specialist, preparing Congressional testimony on a wide
variety of veterans' related legislation. In April 1993, he
was promoted to the position of Assistant Director for
Resource Development.
Mr. Vitikacs' duties with The American Legion include
oversight of Veterans Health Administration medical care
programs, medical construction, the National Cemetery
System, State veterans' programs, and Department of Veterans
Affairs budgetary analysis .
John was born in Frederick, Maryland on September 10,
1952. He graduated from Brownsville Area High School,
Brownsville, Pennsylvania in May 1970. He served on active
duty in the U. S . Army from June 1970 until June 1973. He
received training as a combat intelligence anal yst at Fort
Holabird, Maryland, and serv ed a tour of duty with the 525th
Military Intelligence Group, MACV Headquarters, saigon,
Vietnam. Upon completion of his Vietnam service until
discharge, he was assigned to Supreme Allied Headquarters
Europe, Brussels, Belgium as a personnel security analyst.
Mr. Vitikacs' military decorations include the Bronze Star
Medal (meritorious), Army Commendation medal, and Good
Conduct Medal.
Mr . Vitikacs obtained a Bachelor's Degre,,: in Public
Administration from George Mason University ~n Fairfax,
Virginia and a Graduate Certificate in Legislative Affairs
from George Washington University , Washington, DC . He
belongs to American Legion Post #364, Woodbridge, Virginia.
 61

Statement of
the Nurses Organization of Veterans Affairs
(NOVA)

By
Barbara Frango Zicafoose, MSN, RNCS, ANP
Legislative C~hair

Before the
United States House of Representatives
Committee on Veterans Affairs
Subcommittee on Oversight and Investigations

On
Safety and Secutiry in the Department of Veterans Affairs

May 22, 1997

 62

Mr. Chairman and Members of the Subcommittee, I am BarbaraZicafoose, Nurse

Practitioner in the Center for Outpatient Services at the Veterans Affairs Medical Center in
Salem, Virginia. As Legislative Co-Chair for the Nurses Organization of Veterans Affairs
(NOV A), 1 am pleased to present testimony on safety and security in the Department of
Veterans Affairs (OVA) on behalf of NOVA. 1 speak for our membership and for the more
than 40,000 professional nurses employed by the Department of Veterans Affairs (OVA).

Introduction:
NOVA is a professional organization whose mission is: Shaping and injluencing
professional nursing practice within troe DVA healthcare system. NOVA is very interested in
assuring that the DVA is a safe, secure place for patients, employees, and visitors. Workplace
violence has emerged as a critical safety and health hazard nationally.
Workplace violence is a problem of national scope which can effect everyone. The
magnitude of the problem is well documented in the literature. The 1994 U.S. Department of
Labor report notes that 1,071 workplace deaths occur every day of the year. These statisticses
to an average of three individuals dying at the workplace each and every day of the year.
These statistcs do not account for the additional several hundred innocent bystanders and non-
employees killed yearly. The Bureau of Justice Statistics, -i n a report released in Iuly 1994,
reported that one million individuals are victims of some form of violent crime in the
workplace each year. This represents approximately 1S percent of all violent crimes
committed annually in America. Health care providers are at an increased risk for violence
because they are caring for individuals and families during a time of illness which can
precipitate stress and the sense of loss of control, leading to inappropriate or violent behavior
(Boucher, 1993).
According to one study (Goodman, 1994), between 1980 and 1990, 106 occupational
violence-related deaths occurred among health care workers, 18 of these being registered
nurses. Another study found that nursing staff at a psychiatric hospital sustained 16 assaults
per 100 employees per year. At a time when homicide is the second leading cause of death to
American workers and violence in the workplace is increasing, it is timely that the this
Subcommittee and the DVA investigate workplace safety.

Considerations:
NOVA recognizes the most frequent recommendation for controlling violence at
medical centers is to arm our V A police with guns. We support Secretary Jesse Brown and
the DVA's reluctancea to place firearms in our hospitals. The very presence of a weapon in a
work environment, for whatever reason, can contribute to a triggering event for violence.
Many veterans suffer long-term complications, disabilities, and/or emotional trauma related to
these weapons. Guns are for killing and have no place in institutions developed to promote
health and wellness and the treatment of diseases. The passage of the Brady Bill in 1994
further indicated that with concerted efforts at public education, more stringent measures
could be passed.
 63

NOVA supports an allemalive strategy. Staff education and 1Iaining, along with
knowledge of evaluation and intervention techniques can reduce workplace violence. The
problem with the successful use of staff education and IIaining as a successful intervention
method is a lack of awareness, and in many cases, a belief system that denies the possibility
violence existing in our environment (Kelleher, 1996).
Another consideration related to workplace violence is its cost to the system.
Following a violent incident in the workplace, there is generally loss of productivity, a drop in
morale, people are physically injured, and frequently dozens of individuals are severely
traumatized by the event. Additionally, it is estimated that violent crimes in the workplace (in
1994) caused some 500,000 employees to miss 1,751,000 days of work annually, or an
average of 3.5 day per incident. This missed work equated to approximately $55,000,000.
Experts agree the best approach to reducing workplace violence is prevention and protection
(Brow, 1993; Ducan, 1995; Kelleher, 1996; Labig, 1995; McClure, 1996; McVey, 1996; and
Smith, 1994).

Prevention and Protection:

The Occupational Safety and Health Administration (OSHA) in 1996 published
voluntary, generic safety and health program management guidelines for all employers to use
as a foundation for their safety and health programs, which can include a workplace violence
prevention program. A review of the literature supports this belief that education and
prevention for workplace violence should be the first intervention. Recurring prevention
themes include (but are not limited to): staff education and training; tighter security measures;
adopting a "Zero Tolerance" policy toward unacceptable behavior; developing a Crisis
Management Team which would evaluate any warning and decide what to do about them; and
creating a Trauma Team.
One intervention mentioned, tighter security measures, is critical for the DVA because
of the location of some Medical Centers in high crime areas and the growing implementation
of satellite and mobile clinics. Some physical security measures recommended in the
literature include: increase security personnel on the premises during off duty hours;
improved lighting; beepers for human resources and security personnel; badges for all visitors;
metal detectors in high crime areas; bullet proof glass (especially in ER's and high profile
areas); hidden panic buttons; and closed-circuit television cameras. These cameras would
monitor common areas like stairwells, lobbies, reception areas, smoking and break areas, and
warehouses, where many outbreaks of violence occur. If new mobile clinics are visiting high
crime areas, then NOVA recommends that a security escort be sent with that clinic.
Another intervention is the adoption of a "Zero Tolerance" policy toward unacceptable
behavior. NOVA applauds Secretary Jesse Brown on his recent comments in putting veterans
first (March 20, 1997) where he addressed safety in the workplace and reports that, "Violence,
threats, harassment, intimidation, and other disruptive behavior in our workplace will not be
tolerated." Workplace violence is not limited just to homicide but to those behaviors
identified by Secretary Brown. The "Zero Tolerance" policy identifies and provides a solid
 64

definition of workplace violence It includes: any act which is physically assaultive; behavior
indicating potential for violence (such as shaking fists and throwing objects); any substantial
threat to harm another individual or endanger safety of employees; a significant threat to
destroy property; and aberrant behavior that okay signal emotional distress. Staff need to be
trained to be aware of the warning signs of a potentially violent individual and the method of
reporting such an individual.
A third intervention identified is the creation of a Crisis Management Team. This
team would include the Director, a psychologist with special training in this area, the head ,of
security, and legal counsel with special training. This team would have a written plan to be
followed in a crisis or when there are signs a crisis may occur, evaluate any warnings of
potential violence and decide what actions need to be taken.

A potential lifesaver in workplace violence and one most often overlooked is the
development of a Trauma Team. This team would be composed of trained personnel with
specific "jobs" in the event of a tragedy. It would include such assignments as first aid,
media control, management of onlookers and notification of families.

Sumnuuy:
Over one million employees will be victims of workplace violence this year according
to the Department of Justice. Over one thousand will be murdered at work, and this number
may be conservative. Workplace violence is a problem of epidemic proportions. The
probability of being the victim of workplace violence in some form is about fifteen percent
and growing each year. Violence inflicted upon employees may came from many sources,
including patients, third parties such as robbers, and even coworkers. It can include violent,
threatening, harassing, intimidating, or disruptive behavior. Current literature supports that
there are tactics for evaluatinl! and defusing workplace violence issues without tbe use of
weapons. Staff education and training, along with knowledge of evaIuatio~ and intervention
techniques, can substantially reduce the possibility of workplace violence. Initiating
prevention and intervention techniques as identified can make the workplace safer by stopping
a crisis before it begins.
I would like to thank NOVA's President, Dr. Maura Farrell Miller, PhD, ARNP, CS,
and Legislative Chair, Sarah V. Myers PhD, MSN, RNC, for tbeir assistance in the
preparation of this testimony. Thank you for the opportunity of presenting this written
testimony on behalf of NOVA.
 65

American Federation !I I

GE Government Employees, AFIA'l (

80 F Street. N.v
Washington, D.C. 2w
(202) 737-f..

. STATEMENT BY

ERNEST W. UTTLE

FIRE FIGHTER. DEPARTMENT OF VETERANS AFFAIRS

AND

MEMBER,"AMERICAN FEDERATION OF GOIl.ERNMENT EMPlOYEES LOCAL 331

PERRY POINT. MARYLAND

BEFORE

THE SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

HOUSE COMMITTEE ON VETERANS' AFFAIRS

ON

SAFETY AND SECURITY IN THE VA

MAY 22.1997

CONGRESSIONAL
TESTIMONY
 66

I am Ernest W. Little, a fire fighter employed by the Department of Veterans Affairs

(OVA), at Perry Point, Maryland, and a member of AFGELocaI331.. I am here today on
behalf of the American Federation of Government Employees (AFGE), which represents.
700,000 emplqyees, many of whom work for OVA. We are particular1y pleased to have
this opportunity to appear before you.

Currently, OVA maintains 31 fire departments and AFGE represents the employees
at 21 of those departments. There are five major organizations representing federal fire
fighters--AFGE, the International Association of Fire Chiefs, the International Association
of Fire Fighters, the National Association of Government Employees and the National
Federation of Federal Employees. These five organizations work closely toget!1er on all
federal fire fighter issues. We have discussed this testimony and all agree that if each
were to testify, they would present the same views.

In preparation for today's hearing, we surveyed the 21 fire departments which

AFGE represents. We had only a few days to do this but were pleased with about a 35%
response rate and will refer to the information obtained throughout this testimony.

We will focus our remarks on OVA fire service and present the views of our OVA
fire fighter members. Their particular concerns are the fire protection afforded our .
nation's veterans at OVA medical centers throughout the country and the opportunities
which exist to utilize the fire service to provide needed services at great cost savings to
OVA.

I want to stress that AFGE has been working closely with the Administration in its
reinvention efforts. We endorse the goal of an effICient, cost effective service which
places its customers first. To this end, we have met with Secretary Jesse Brown and
discussed the advantages to OVA of having the authority to enter into sharing . .
arrangements. Our position has been that prior to entering into such arrangements, the
full scope of the work must be determined, its cost calculated and an accurate .
comparison between in-house performance and performance by outsourcing must be
made. In addition, AFGE has long been an advocate for seeking new ways to do
business which will both improve the service provided to customers and be cost effective.
Unfortunately, the OVA fire service has not benefited from any in-depth analysis and in
fact, appears to be viewed solely as a source of revenue drain rather than a critical
component of caring for our nations veterans.

Today, we would like to focus onlwo main points. First, millions of dollars in
savings could be achieved if OVA would emulate fire services around the couAlly and
take advantage of the full range of emergency services which fire fighters are uniquely
qualified to provide. Second, at the present time, veterans who are patients at Medical
Centers as well as employees are at great risk at most facilities because of OVA's
inattention to its fire service. .

To fully understand the importance of these points, some background may be

necessary.

Today's Fire Service.

Beginning in the early 1980's, fire incidents were drastically reduced. This was
directly attributable to the fire services' public education efforts, widespread prevemion
and protection measures, and the establishment and enforcement of better fire safety
codes.

At the same time, communities nationwide began calling upon their fire
departments to respond to all types of emergencies-hazardous materials incidents,
crash/rescue efforts, and emergency medical services-and most now have EMtn ch8nged
their names to rellectthat they are now no longer just fire departments but ra~r,

2
 67

emergency services departments.

This also coincides with the changes taking place in the medical profession. The
provision of both Basic and Advanced ute Support by Emergency Technicians is saving
communities millions of dollars by utilizing fire fighters for this ,function. There is now
widespread recognition of the need for on-the-scene immediate care prior to transport; an
emergency service which fire fighters can easily fulfill and which enables hospitals to
significantly reduce emergency room services and personnel. In addition, it is now well
established that immediate emergency medical attention not only saves lives but reduces
the time and attendant costs needed for recovery.

Unfortunately, the federal government has not completely recognized these

changes, although the Department of Defense (000), which employs 98% of all federal
fire fighters, has taken the first step. Its File and Emergency Services Quality Working
Group adopted a five-year strategic plan which included the goal of having 000 fire
departments assume full responsibility for all emergency medical services at 000
facilities.

Fire Fighting Is A Science.

Over the years, research has yielded certain scientific facts pertaining to fire
suppression. Most important among those facts is that sprinklered buildings reduce fire
loss but not fire risk. When there is a fire, the high use of plastiCS and other synthetiC
materials, particularly at medical facilities, results in an extremely hot, fast-burning fire
which produces an increased amount of toxin-carrying smoke.

For example, articles which contain polyvinylchoride (PVC's) can melt when
exposed to heat, creating a highly toxic vapor. As fire fighters say: one whiff and you
wonder what it is; but you'll never know because after the second whiff, you're dead.

Today, there are more deaths from smoke inhalation than there are from fire burn.
The highest injury and death rate from burns and smoke inhalation occur to people who
are unable to evacuate buildings such as the elderly, the sick or those who are easily
confused such as the mentally ill, mentally retarded, those suffering from Alzheimer's or
who have damage from substance abuse--the very type of patients at VA Medical
Centers.

Response Times Are Critical.

Both fire suppression and emergency medical services s,hould always be

discussed in terms of response times. It is well known how long it takes before a fire
results in a total loss. A graphic example of this can be seen in a film developed by the
National Fire Prevention Association (NFPA) which promulgates national consensus
standards pertaining to the fire service. This film shows that within 40 seconds of
dropping a lighted cigarette between two sofa cushions, the cushions will begin to
smolder, giving off toxic fumes. Within, 5 minutes there is a total flash-over--resulting in
heat so high that it becomes impossible to enter the room. Within 10 minutes, the room
is filled with vaporous fuel, creating a backdraft condition that results in total loss. Thus,
failure to respond within 10 minutes is extremely dangerous.

Staffing Of Fire Departments Can Be Determined With Accuracy.

Perhaps more so than for any other occupation, the absolute minimum staffing
levels for fire departments can be determined with precision and accuracy. It is based on
the basic equipment needed and the number of men needed to operate the equipment
safely.

The starting point for determining staffing .levels is the risk assessment. Risk
assessments force you to go beyond the narrow confines of fire suppression. They
incorporate the functions provided by the Federal fire service today by considering factors

3
 68

such as EMS, HazMat and fire prevention and maintenance-all of which are vital if the
risk to people and property is to be contained.

Once the risk assessment has been undertaken, then the equipment needs can be
determined. After decisions are made on the number of companies needed to meet
response times and the number of units of mobile equipment which are required to meet
relevant standards, then proper staffing levels can be determined.

The national consensus standards adopted by both OSHA and OVA recognize the
need for four fire fighters to respond to a fire. Two go in and attack the fire; one serves
as a back-up in case the first two go down; and one operates radio command, the
pumper, etc. To have fewer fire fighters means the fire fighters and the patientli they are
trying to protect are placed at an even greater risk.

As an example, we can your attention to the recent incident which occurred in

neighboring Prinoe Georges County, Maryland. A fire alarm went off in early April.
Because the county fire department was underfunded, the closest fire station was closed.
The next closest station could not meet and did not meet the minimum 10 minute
response time. When the fire fighters arrived, the fire was so advanced that nothing
could be saved . However, the more tragic part of this story is that because only two fire
fighters responded, the small child trapped inside the buming building could not be
saved. This could have been the story at a lock-down psychiatric unit at a VA medical
center.

Not only is it recommended that a minimum of four men respond to a fire incident,
but NFPA 1200, which is currently being considered by the committee, proposes that a
fire department be able to have 10-12 men at the scene of a fire within 10 minutes of a
fire alarm and that the initial response be made within 4 minutes.

After the number of individuals needed to operate the equipment in accordance

with the regulatory staffing requirements has been determined, this number should be
multiplied by the appropriate Manpower Staffing Factor. This factor is the number of men
needed to insure 24 hours per day staffing after taking into account annual and sick
leave, jury duty, reserve guard duty, training, etc.

For example, if the risk assessment determines a need for one pumper and the
relevant staffing standard for that pumper is 4 men, and each of those men worked shifts
of 24 hours on and 24 hours off, then you would need a total of 8 men to cover 24 hours
per day, seven days per week. After taking into account, holidays, jury duty, etc., you
probably need 2.8 to 3.4 men.

Now let's see how the operation of the OVA fire departments stack up against
these facts.

Millions of Dollars In Savings Could Be Achieyed .

If OVA would emulate fire services around the country and take advantage of the
full range of emergency services which fire fighters are uniquely qualified to provide, it
could save millions of dollars and provide a needed and necessary service to the
veterans of this country and to OVA employees.

There is already a shining example of this within the system. AFGE Local 1119 at
the Montrose VA, New York, submitted a proposal to management last December to
canoel the contract with an ambulanoe service and to permit the fire department to take
over this service. The Director agreed and here is what happened:

The contract for ambulanoe service-costing $207,000 per year <and estimated to
increase by $50,000 to $60,000 annuaRy because of the facility's closure of its ICU
unit which means that more patients would have to be transported off-lite)-waS
cancelled.

4
 69

An ambulance (demo model) was acquired for a cost of $75,000.

The fire service took over the ambulance function-with no increase in staff-on
April 4.

Those fire fighters opet'8ting the ambulance are certified emergency medical
technicians and because basic life support is now one of their primary duties, they
areentitled to a grade increase which increased the salary costs to the VA by
approximately $95,000 annually but which still meant that the VA will save
$160,000 or more annually after the first year.

The in-house response time is under 4 minutes as contrasted with the contractor
service which was between 112 and two hours.

At the present time, the fire department is manned by a staff of six. This enables
four men to be ready to respond to a fire while two can operate the ambulance.
Obviously, this does not allow for employees on leave. In that case as well as in
the case wilen the ambulance needs to leave the facility to transport to another
hospital, a nurse is used in the ambulance. Recognizing this shortfall, the fire
fighters are suggesting increased staffing in the fire department and a
corresponding reduction in the nursing unit. This too will save money because
nursing personnel are paid more than the fire flghterlEMTs and receive overtime
after 40 hours whereas fire fighters do not receive overtime until after 53 hours per
week.

Finally, assumption of the emergency medical service and providing basic life
support to those at the Center not only will save over $160,000 per year and
provide a much higher quality service to those at the facility but it was a job easily
assumed by current employees who are already trained to respond. (Copies of the
Montrose fire fighters' proposal to take over this function is attached.)

The same type of proposal including providing EMS service to adjacent federal
buildings on a reimbursable basis was submitted by an IAFF local in Minneapolis. The
Director concluded he was not interested. In fact, he has indicated that he is not
interested in keeping the fire department. He simply wants to outsource regardless of the
impact on veterans or of the. cost. How can the VA justify a failure to take advantage of
cost savings which include providing quality service to our Veterans and how can it justify
the risk understaffing of fire departments places everyone at a VAMC in?

DVA Patients Employees and Fire Fighters are at Great Risk.

The second point _ want to discuss today is the risk veterans and employees
face at most facilities now and the likelihood that this risk will increase if
recommendations for sharing arrangements or other outsourcing measures currently
proposed are actually implemented.

The situation at most DVA fire departments is so egregious that it can only be
characterized as a "disaster waiting to happen". As always, staffing and response times
should be considered first and foremost.

Last September, the award for the best DVA Fire Department was given to
American Lake, in Tacoma, WA. Now, a sharing arrangement with Ft. lewis is all but
finalized.

This facility consists of 60 structures on 360 acres including a lake. Beside the
medical facilities, there are ten residential houses. The medical unit houses psychiatric
patents many of whom must be kept in a locked unit, and geriatric, Alzheimer, post
traumatic stress, substance abuse and blind rehabilitation units housing some 350
patients at any given time. It has one fire department staffed with five fire fighters and
one chief plus four temporary fire fighters for a total of 10 personnel or 5 on duty at any

5
 70

given time if no one is on leave, attending training, on jury duty or reserve military duty.
It has two vehicles. As currently configured, it cannot meet the required staffing of 14 fire
fighters and a Chief. The fire department cannot meet the requirement of a four-man
response but it does the best it can.

The department costs approximately $464,000 per year to operate. In addition to

providing fire suppression services, this undermanned department also provides police
back-up equal to 2 FTE's, sprinkler and fire alarm maintenance equivalent to 2 FTE's,
patient transport via ambulance/escort equivalent equal to oneFTE, and estimates that
by handling snow removal it saves the facility $20,000 in overtime. These savings are
not reflected in the operating budget nor were they considered when the cost of the Ft.
Lewis sharing arrangement was determined.

Consonant with OVA's policy of pursuing sharing arrangements, American Lake

approached the county. County officials were not interested but did say: (1) fire
suppression only would cost in excess of $300,000 per year, (2) their best boat response
time would be one-half hour although fire suppression might be around 10 minutes, (3)
they would respond to a call within the county before responding to the VA facility, and
(4) would leave the scene of a VA fire incident to respond to one within the county.

Next, the facility contacted Ft. lewis, which has offered to take on fire suppression
services only at a cost in the neighborhood of $165,000. Its normal response time would
be in the 12 to 14 minute range.

Using Ft. lewis would cost less that what is required to operate the American lake
fire department. But is the risk worthwhile? let's look at what will be lost:

The five positions now backfilled by the fire fighters will have to be filled.

The estimated $20,000 in overtime for snow removal will have to be paid.

If there is a fire, it is doubtful that Ft. lewis can respond within the critical 10
minute period so it could result in loss of property and perhaps even lives.

A contractor will have to be hired to maintain the sprinkler and fire alarm systems.

The fact that Ft. lewis will not provide boat rescue for patients who wander into
the lake was brought to the facility's attention and they indicated this could be
handled by the County. Any water rescue delayed for the one-half hour county
response time is likely to result in death. .

Elevator rescues will no longer be done by the fire department but will instead be
handled by the contractor who services the elevators. The contractor will do his
best to respond within one hour. Just last week,thefire department responded to
three elevator emergencies in one day. One of the incidents involved a patient
being moved from surgery to ICU. Should patients wait for an hour or more in a
stuck elevator before rescue?

Quite honestly, the facts indicate that a sharing arrangement will yield little if any
cost savings but the impact will adversely and seriously disadvantage patients and
others. The American lake fire fighters are puzzled, to put in mildly, by this decision.
We ask: is this the reward for being the best OVA Fire Department?

Other VA fire departments report much the same thing. The Chillicothe, Ohio,
OVA fire department reports that it has 60 buildings on its 307 acres including 14 housing
units. It is currently staffed with 13 fire fighters and 1 Deputy Chief. This means, at a
maximum, 7 men are on duty at any given time--which is certainly not enough to operate
the equipment. Chillicothe, to the best of the fire fighters' knowledge, including the
Deputy Chief, has never undertaken a formal risk assessment. But, even under any
assessment or under any standards, its current level of staffing is far short of the number

6
 71

of men required to perform the job at all. In short, it would be almost humanly impossible
to control and extinguish a major fire. During 1996 the department responded to 516 fire
alarms, 84 code oranges (disturbances), 24 code blues, 20 helipad response stand-bys,
99 ambulance runs, and 227 patient transports. That's 670 responses. The closest fire
department is totally volunteer and its response time is 15 to 20 minutes. Certainly,
reliance on it for fire suppression would be pure folly. Chillicothe has a lake and it does
boat rescues. It has multi-storied buildings and does elevator rescue... It has wards
housing psychiatric, Alzheimer's, geriatric, hospice, cancer, and substance abuse
patients. It must continue to have its own fire department which must be staffed at a
level to meet the most minimal standards.

At Ft. Meade VAMC, South Dakota, the facility encompasses almost 8,000 acres
with 878,600 gross square feet of occupied space including hospital, workshop, offices
and housing including shelter for up to 400 National Guardsmen. At any given time,
there may be as many as 1,600 people on the facility. The fire department currently has
a staff of 12: one fire Chief, 3 captains, 3 driver/operators and 5 line fire fighters-which is
insufficient to meet any applicable standards. The last risk assessment was done in
1993, which is totally out of date unless there have been absolutely no changes at the
facility in the last four years. The closest fire department which could enter into a sharing
arrangement is the Sturgis Volunteer Fire Department, which is all volunteer and does not
operate an ambulance. The response time for this Department is 15 minutes after the
volunteers have responded. Veterans and other, including the fire fighters, at Ft. Meade
should not be placed at great risk simply because the VA fails to meet staffing standards
nor should they be placed at even greater risk by relying on the Sturgis Volunteer Fire
Department which cannot meet any reasonable response times and which uses only
volunteers who mayor may not be available at any given point in time.

Battle Creek VAMC in Michigan is contemplating dual-hatting its fire fighters and
police. Under the proposal, these men would become Public Safety Officers. We
recognize that there are certain law enforcement functions easily and currently performed
by the fire fighters, but these are generally confined to inspection and enforcement of
codes and regulations. The apprehension and detention of those violating criminal
statutes is not something a fire fighter would routinely do but more importantly, if an
emergency alarm were sounded during the search for a suspect, to which of these
serious incidents would a fire fighter's obligation lie? Battle Creek has approximately 600
patients with a current fire fighter staff of 10, plus 3 temporary employees. Their staffing
meets no applicable standards. The nearest fire department (Battle Creek) can respond
to the facility in 12 minutes or more. As pointed out above, this is too long particularly
when you have non ambulatory patients and those in locked psychiatric wards.

Sheridan, WY VAMC is staffed so that it can operate its three pieces of equipment-
-on Tuesdays-when staffing off days overlap. Let's hope Sheridan'S emergency calls are
limited to Tuesday occurrences but that's unlikely given its average of over 370
emergency responses per year. Sheridan is fortunate in that the Sheridan City Fire
Department can respond in eight or more minutes. Thus, a fire incident might not result
in a total loss. The City can respond under the mutual aid agreement. Notwithstanding
this, we ask why the OVA is placing everyone at Sheridan VAMC at such great risk
simply by understaffing the fire department?

In addition to these facts, we point out to the Committee that at each VA Fire
Department, the fire fighters perform an incredible array of necessary duties all of which
must be performed and will continue to have to be performed either by a contractor or by
hiring additional personnel. The following are just some of the examples: fire and safety
inspection; fire alarm and fire suppression system (sprinkler and fire extinguisher
maintenance and inspections); confined space assessment for hazardous atmosphere
and confined space rescue; emergency medical response which, at some facilities,
includes both basic and advanced life support; patient transport to other facilities or
airports; hazardous materials response, assessment and cleanup; vehicle extrication for
accident victims; sole answering point for 911 calls; after hours inspection of facilities and
construction sites; employee fire and safety training, fire drills and new employee

7
 72

orientation; engineering service call taking and assessment after duty hours, weekends
and holidays; alternative answering point for hospital after hours, weekends and holidays;
security runs off station; police backup; snow removal; maintenance of fire vehicles and
equipment; and assisting engineering in clearing roadways blocked by natural disasters.

Mr. Chairman and members of the Committee, we bring these facts to your
attention in the hope that you will pursue this issue. Our recommendation is quite simple.
Where critical response times can be met by a fire service located near a OVA facility,
sharing or outsourcing arrangements should be explored. Exploration should include not
only comparing the full scope of work currently performed by the fire department but the
additional functions such as EMS, which the fire department could perform without an
increase in staff above those needed to meet staffing standards and which would save
money and provide a quality service. Montrose VA is a prime example of the assumption
of additional duties at a great savings to the OVA.

Where critical response times cannot be met, then the VA must take needed action
to insure that veterans and employees are protected adequately. This includes meeting
minimum staffing standards without the widespread use of temporaries which has been
so prevalent throughout the VA over the last four or more years. Further, dual-hatting
should not be practiced where it provides an inherent conflict such as the dual-hatting
(policelfire fighter) proposal being considered by Battle Creek. In addition, the Montrose
VA example should be given serious consideration as an appropriate adjunct to the
services now offered by the fire department.

AFGE would welcome the opportunity to work with the Committee to explore ways
in which the Department of Veterans Affairs' FIRE AND EMERGENCY SERVICES can be
provided at all OVA facilities in the most efficient and effective manner-providing a quality
service for its customers--our nations veterans--at the most realistic cost.

Again, we thank you for this opportunity to appear today.

8
 73

AFGE has no grants or contracts to declara.

9
 74

BIOGRAPHY
of
ERNEST W. LITTLE

Ernest W. Little is a fire In addition to his work at

fighter employed by the Perry Point, Mr. Little
Department of Veterans Affairs utilizes his experience and
at Perry Point, Maryland . In skills as a volunteer for his
addition, he is a part-time local community volunteer fire
support instructor for the department.
Maryland Fire and Rescue
Institute, special programs Mr. Little and his wife,
section. Sharon, reside in Elkton
Maryland.
He has 12 years experience as a
fire fighter including six
years with the Department of
Veterans Affairs . He has
served as a lieutenant and a
captain in the fire service.
Ernie highly proficient and
skilled at fire suppression,
fire inspection, confined space
rescue, high angle rope rescue
and vehicle rescue.
He holds many certifications
including Fire Fighter II, Fire
Officer II, Fire Service
Instructor III, and Hazardous
Material Technician.
Mr. Little is an active member
of AFGE Local 331 Perry Point,
Maryland and participates in
many union activities. He is a
member of the AFGE Fire
Fighters Steering Committee
which consists of all federal
fire fighters who are also
members of AFGE. The coalition
recommends policy to AFGE's
National Executive Council on
issues directly impacting
federal fire fighters.
~
~

~
...~
III
National Board on Fire Service
Professional Qualifications
It is hereby confirmed that
ERNEST WILSON LITTLE
having been examined by an accredited agency in the
-.:!
National fro/essional Qualifications System is certified as C1t

FIRE FIGHTER 11
JUM26, 1995

(]&oM jr..;....!.Q
I . )CCICIIIy 10 III. B.,.", UCholnntnol-m;.;,J
~
emilie,,", 276'111
"
~
~

~
..'" National Board on Fire Service
Qi
Professional Qualifications
II is hereby confirmed that
Ernest Wilson Little
having been examined by an accredited agency in the
NaJiona/ Professional Qualifications System is certified as -::a
CI)

FIRE OFFICER 11
January 22, 1997

[J(o7J/ il
* ..*
.*. Jr..;,... z.Q
)""'Iaty 10 I~'" Boan! . *iclf-* { rc;;;J;;- ----,
V ClWIIIIIII or !he Board
~ tMs
B Cenifi..
le' 35803
 o
II.

National Board 011 Fire Service

Professional Qualifications
It is hereby confirmed that
ERNEST WILSON LITTLE
having been examined by an accredited agency in the
National Professional Qualifications System is certified as ~
-:I

FIRE INSTRUCTOR III

June 24, 1996
I
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...... (jrRf)~ ""* ...* }~~
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'!ec",wy 10 the Boon! *ir .* Chlinnlll of doe Board
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i
 78

COURSE HOURS INSmtmON

BASIC FJRmGH'IlNG 80 MFR.l
f1RE(]ROUND OPERATIONS 1 24 MFR.l
PIREGROUND OPERATIONS 2 24 MFR.l
'IRUCK COMPANY OPERATIONS 24 MFR.l
PUMPS 24 MFRI
AERIAL OPERATOR 12 MFRI
RESCUEncHNICIAN 45 MFRI
FIRE COMMAND 1 27 MFRI
FIRST RESPONDER. SO MIEMSS
HAZARDOUS MATERIAL TECHNIClAN 40 aM
HAZARDOUS MATERIAL 1'ECHNICIAN REFRESHER.
NFA LEADERSHIP 1
12
.. OES
NFA
NFA LEADERSHIP 2 12 NFA
NFA LEADERSHIP 3 12 NFA
MARYLAND CHIEF OFFICERS SEMINAR 1993 12 MFR.l
MAlt.YLAND CHIEF OFFICERS SEMINAR 1994 12 MFRI
CONFINED SPACE RESCUE 40 WVFA
GOVERNORS FIRE AND BURN CONFERENCE 1993
GOVERNORS FIRE AND BURN CONFERENCE 1994
I
MFRI
MFR.l
FIRE PREVENTION AND SUPPRESSION 80 DVA
INCIDENT SAfETY OFFICER 12 NFA
HEALTII AND SAFETY OfFICER 12 NFA
PORT .AND MAlUNA FlREFIGHi"ING 12 MFR.l
SPRlNKLERS AND STANDPIPES
ItADlOLOGICAL EMERGENCY MANAGEMENT
12
' MFR.l
FEMA
NFA B'lJU..DlNG CONSllUJC11ON 1 12 MFR.l
NFPA 2S SPRINKLmlS
MANAGING COMPANY TACTICAL OPERATIONS
12
MFRI
NFA
NFA FIRE ARSON DETEC110N 16 HACC
NFPA 101 Ln'E SAFElY CODE UPDATE 1995 4 DVA
LEADI!R.SIDP AND SUPERVISION 18 MFRI
CODES AND STANDARDS RESEARCH SEMINAR 8 MFRI
ExECUllVE DEVELOPMENT SEMINAR NFPA 1021
2-2.1,2-2.2,2-2.3.~2.2,4-2.2,4-2.3,4-S.1.4-H.4-S.S 6 MFRI
NA11JRAL GAS EMERGENCIES 4 HACC
EASTERN UNITED STATES TECHNICAL RESCUE SCHOOL 87 FIRES
FIRE OFFICER. 1 60 MFR.l
HIGH ANGLE RESCUE 12 MFRI
SCOTT AIR PACK FIELD LEVEL MAINtENANCE 3 SA
OPEN WATER. SCUBA DIVER 40 PADI
MEmODS OF INS'IRUCTION LEVEL 2 54 MFRI
INSTR.UCTOR SKILLS SPECIAL PROGRAMS MFR.l 12 MFRI
 79

11.\1.1; PUMP SF."UN.-.R NJ'l'!\ 1l102 2-2, 3-\.211

GOVERN()1tS FlR.E AND BURN CONFERENCE 1996
8
MT'RI
Mr'Rl
F.XECtJTfVF. DEVI!LOPMENT St:MlNAR Nf'Pi\ lOll 6 MFR.I
2-13.13-13.14-13.1
FIIlli o",.,CF.R 2 42 MFRl
!'osrnVE PRl::.'lSlJRE VE!-f111 .ATION 12 MFR1
RADIOl.OGICAL EMERGENCY RF.SPONSIi MSI-I g PF.(,O
~HRYL\ND CHlF.F OrnCIiRS SElvUNAR 1997 12 MFRl
H.-.LAlU)OUS MATI:'.lUAL TF.CHNl<..~lAN 32 USI'.PA
ICERESCllli 8 Ml'1U
tNFF.CnON (:ONTROl. h)R EMF.RGENCY RF.SP<>NSI' 12 NI'A
!'t-:R.SONNE!..
F ,\ltM ACCIDENT RESCUIi 12 Ml'lU
INCIDENT COMMAND SYSTE..\1 EMS 16 NT'A
MFRIROPF. REseu!: U 'VF.L m 12 lVU'Rl
,\MTRACK FIRE & Rt-:SClJE SEMINAR K ,\MTRACK
:-1I'A-lNlTl:\I. FIIlli INVF.STIGAUON -40 Mt"Ri

90-d
 80

HAec HARlUS}UJRG AREA COMMUNITY COllF.GE

MFRl MAR'iL\ND ""IRE ....NI) RESCUE INS"lTrLn
MIl~MSS MARYJ.ANI> INSTHUTE FOR F.MllR<iF.NC'Y MEDICAl . SERVICt-:S
OM GI:l~AGlIT)'" ,\),1) MIllER COMPANY
GES <;U:\I{I)IAN J-:NVIR()N!I.IF.NTAl St'RVICr.:s
),'1'11. NA'nONAI.. I-lIU-: ACADEMY
DVA DEPARTME.."IT OF VETERANS Al'FAJRS
FEMA' FEDERt\L EMF.RGENCY MAN:\(jF.ME~'1' AGENCY
FIRES I-1RF.l-1vln'lNG AND RF.SCUJ:: liDlJCA110NAJ. SERVICEs
SA seOTI AViATION
l'i\I)[ PROFESSION,\)'. ASSoCIAUOJ-.: OF orVIN(, INSTRUCTORS
PEl'O Plm A\)fo:l.l'HI.'I. E1.f.erruc COMI'A."IY
USlli'A L1-<TIl'.I) STATES cNVm.ON~n;Nr,\L PRo'n,c-nON AGl' :-.iCY

~I ,\R.YL,\ND CERT'IFlliD l'IRF.FlGlIl'cR 11 n..'NE 31l,1995

MAlt n ANI) L'ERnFlF.l) l'lRF. OF-'FICl!K n FF.BRU,I\RY 25,19')7
~i,\RYLA),'J) CF.RTll'n:,n FIRE S1!.R\lCF. INSTRUCTOR ill Jl.:}'T: 16.1996

N,'\TIONAl. CF.RTIFlliD FlREFlvllTF.R n JUNE 26,1995

NAll0NAI. CERll1'U-:DFIRE OFHCF.R n 1ANUARY 22.1997
!'oJ,,\nONA!. CI'.RllFIED FIRE SF.RVICE INSTRUn'C)R m 1ULY 15,1996
 81

S{:JNDJ
;:-;eO.!?'? - t2J/I~,epV' {!,,(/9"c k .
/!~g-L - ///1
DEPARTMENT OF VETERANS AFFAIRS

FRANKUNDELANO ROOSEVELT
VA HOSPITAL
P. O. BOX
.'
100 :

MONTROSE, NY 10548-0100

FTS FAX: 700-887---

I
I
COMl\llEItCIAL
.
FAX: 914-737-4400,xol5(/3

FTS TELEPHONE: 700- 8 8 7 - _ _

_ .

IAFOIU.I
10 'd 555 '00 X\I~ V IN OS : 11 3Ill LS-oZ-AII1I
 82

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DEPAIIlIIfHT IlAWNGI.DfUI, FOtJIIRUY 1IWI\ED lIEN ON STAllON 10 RESI'OND 10 ARE
EIIERGENaO AM) snu.AU.OW RIll.satEIJIUD II/L

2) THE ~ DEPAJmIENI' PIIISEIiIIl.Y MASlEN EII1' S JNa1IIIIN6 lH RIlE O\IEF. AU. PIIfSENT
RIlE IIB'AIIlIIfHT PEIISOIW. WOOUI BE 61W11FA1IIfJIED IN AMI .Ill. NEW RIllES WOtJU) MaT THE
NEW CEII1W'ICA1ION IIf4UIIEIIIM5 RlR THE DEPARlIIfHI'. THIS WCIlUIIIEEP A _ l i t OF JWO lIEN
ON DtI1Y AT .Ill. TIII!S. NESENnY EIfT Q.UIES IQI fGUl TO &IX 1ICINIII8..Ill. RIISIEN AT1ENDIN6.
11tIS 1ILUI\BI& WOWIIE 6IWH 111 11iI fJA' IF TIIY AII W8IlUI8 ON THE DAY OF CUSS AND lIE
-GlVEMCOIIP. 'lIME fOIl THE HOOIIS ON 1HEUl DAlS OFF.

3) THE ADDfIIOI!IoU. 1UNN6 DPEIl1lS AM) WOIlK UMB WCIlUI BE EXIENSM, IECAUS OF
THIll WE ~1HAT lIIf VA. AIITOIIA1lCoW.Y 6IYE ACII FIIlD'IGIITR " I'JIFOIIIANCE AWARD
OF ".000.00 PEa WAIL THIS WOWI BE IN UBI OF S1!P8. 1lBS AIICQIJ WOWI BE 6M'N 0NCf:"
\'QII ... TIIE RRST PAY PBIJOG ... DfaIIIEJL 11118 WOWI AFfORD THE YA. IIORE CONIIlOl OIlER THE
~ AND aCarUROCES$, I!!O flBDf!r.AJION NO AWARD! .AOOfilcINALY. lH VA. WOWI
IIlIlElPONSlBa RlR ALI: INCUIED COSIS RElAllNG:ro 1lmON, ON GOIN6 lIWNlN6, BOOKS AND
MATEJIW.S.

4) WHEN THE RAE DEPARlMENI TMNSPORlS" PAllENT OFF STAlION THE AREfI6H1ER an
(I:OIIMR) WIU. tIE AOOOIIPANIEIIIN THEAllIIIJUNCf 8Y AN RHo THE OOCIOR 1IIEA1ING THE
PAllfNl' WILl Df'IBIIDElF THIS 1RANSPOR11S.u.s. OR ILLS. IF DEIBlIIINED u.s. AN JlNIIUST
IE ON IIOo\RD THE A118t1UNCE.

S) THE HOSPITAL WOUJI NEED A SCOND AMlMANC:E 10 11m tilE NEEDS OF 1JIAHSPOKIIH&
PAllENJ'S OFF STAlION. lH PIlESENJ AIIIIlJlANCE lIiOlJU) SllL1. BE ASSIGNED 10 IN STAnN CAllS,
CODES. FJRr.:5 ANO 01lIflt EIIEJl6fNQfS. TIlE PIIfSENT AMIItlANO! AT CASII.E POINTYA. WOlJlD1IE
tlSED AS A BACK llPtuG 10 aJWR AN ~ BEING our FOR OR OF SElMa:.

7) THIS wou. IIIE1THE l\IANSPOnAlION NEEDS Off STA"!1ON 24 IIOUIS ~ DAY. 11 WOWI
CONIIM 10 IlAlNTAN 1IIE PRfSENT UFE SAFE1Y JlBlUllMEH18 FOR P"1J!N1' AMI STAFF AMI BE AIIl.E
10 IlANTAIN tilE COWERAGf OF CAlLS ON STAllON. tilE HOSPITAL rosr WOOlJ) NOT EXCEED AND BE
F_ l&S THAN THE PIIfRNJ CON1'RACJ rosr OF 1207,000.00 WHIOI WlU.IIOST UKLY INCllEUE
AIIOIJ1' ISO eo,ooo.OO IKE 10 THE ESllMATED JNalfASE OF 50 70 PAllENIS BEING SHIPPm OUT A
w;g DUE 10 Iell Q.OSIN6. (NtJMBERS .\QI.lIRED FROM MEDICAl SElMCE)

555 PA:;E.02
 83

JQTM FSDMUfD con m DIE HfRIDI ARE AS mt INS;

.) 195,000.00 11IU FnE RlI&t6II1ER BIT POSI1IONS

B) '.5,000.00 .wouL PEIlFOItIllANCE .W4ROS (BASED ON 15 EMlS)

5140.000.00 TOTAL COST PER WAIl

IF YOIIIU.\ MI'I QIDS'IIONS Pl\Sf: FEEL FII!E TO CONJ-'CT US AT EXIENSION 2332 08 27.2.

RESPfClRJU.y staIlIED,

VA. FlR DEP.umlENT

1I0NIII06E. NoY.

555 PA:;E.03
 84

~".1111H1

IIONIIIOSE VA. ADIIII\ISJRAIION

BI.D .1
IIIONIIICa N.Y

........IT MAYCONCBIN,
AS JIB WUlIIBltESI' WE IIA\WORIIED lItE lASJ R.W DAIS PlIIIN61O&E111Bt _ l I O N AND
PIlICIN6 ON N!W A1111lLUNCES RIll tHE N!W 1IlANSI'OIIT PII06IWI YOIJ ARE MlRIIINIII ON. WE RAW
CGIIE Uo lWI1I1H RM..I.OWINCi IIIIJUNE ON POSSI8U OPIIONS lIIATWUlU 1B:r ... JI&DL

oPnON 1) &SA SPB) nPE 1

EN6II\E,AIIJO, 12,_ _ _ SJJmIED IMJIMI_.
WIIEBID c.DJDf 41C6 ON It atlVY U50I QIM6IS .... DIESEl..
lNI'.
SS..soo.oo APROIX. aIST
.w IIONIII (APIIIL'" DBJWBY
OPlION 2) BID SPB)nPE , WHEElED mtJaI ..leA ON It RIIlD f.358 CIIASSIS 7.3L DIESEL
EN6INE, AlII'O, 11._ _ _ III6REIl QUAU1Y 1Nf.
$11.eoo.oo APIIOX. cosr
3 IIION1II (fEIIUUY.., DELMIIY

CPIION 3) DEMO nPE 1 umm c:ouat 4112 ON It FORD ","0 OIASSIS 7.31.11ESB. EMIDE,
AlII'O, 11,GOC1GW'. I1I6IIEIl QUAU1Y INf WfI'H ElCIIIA OPIIOIIB ALLIIfADY ON 1Nf.
$1'5.300.00 APIIOX. aIST
1IIIIfD1A1E DEUWIlY

0PIl0N .. ) DElIO nPE a umm COOOt 4112 ON It FORD E-350 VAN Q/lltWltY OIASSIS 7.31.
EN6INE, AlII'O, 1D,5C1011\'W. III6IIEII QUAU1Y 1Nf.
$84,000.00 APROX. aIST
.aM1E IIEIJ\'Bn'

0PlI0NS 2 THll\I 4 ARE amAIN SPB:. 6RADE MlIJl1IANaS 'MIlCH ARE BUU' WfI'H 1U6IIEII QUAU1Y
MTEIIIALS AND srAMWIDL 1JIR lNlS WOUD IoEID ... GO 1HIIU 1IIE IIDOM PIIOCI5S IN _
P\IICtIASIN& 1IIPf'AII'IIIBI. OPIION 1 IS It fEDEBAl fIlA SPEC AIIIlIAMlE IS It UMH CIUWIY INf
WfI'H tHE lIfAR IIINlIMI BlUI'IIIENf AND AlSO HAS 1HE l.ON6f5T DELMIIY lIME au; ... It aIASSII
 85

SIIOR1'MIE. 1H 68A I.NT CAN . . PWOW8) BY ..... .-uN& A 1IABII..--aAHCE II8PSI1ION

RIB (CM FOIIII 1781). . . . . 11IWI. DO NOt IIIIClIIIEA S1IIEQIEB ( " . . . . . . OISI')

lfASIN& IS ALSo AVALIBlE WI1H 1IIESE W1L CM IDlE IMS 1H IIMIIEB IDlE 1lA1 MSm ON
_ l I O N 8U'I'UID BYWIIEflID muat THE fIDEIW. 8IMJIIIEIII( ~ FGR
-.uNaEL IRNC2PLE TAX fREE lAIIS AlII! AVAlal.t: 10 US AT A ~ lIAR AND _WOILD END
U" ~ lIE INI' 4TlIIE END GFlIE lUI!. (IEEATTAaiED lDaIG QIlII1I!S)

USED ON THE A8IW NUIaIms AND THE PIIOIECIED QJ8T GF 1HIS NEW lUNSI'CIftT PIlOIlR.W. 111(
-.uNCE IF PUlaMSlDOUIIIIIKI' WQILD PAY . . . 11IBI' III U!l811W1 ONE WAIL PlSI1E IIEFIB
10 lItE IElIAIIPlI: IIEUIIW.

$ 75,3C1G.08 AMMUNClE Pl.BCIWIE BASED ON HI&IIISIINT ( OUIIIICIIT IIlN l

$1115,5GO..OO 1ItTAL QJ8T GF P8CIPGSBI PIAN . . lItE Rar 1fAII

S 11 . fIO IiAMNII6 DIE BASI JfM AND ,.., Nepjw PMD _ AMIIIIM!!jE

. . . . . ..",. . . DIf tSIJM)QR . . WWlllQf PAWBIII mlHf I fIIl)Q8

ReM"MMD-

IIICII' wElIA\, PIlCMDED EIiIOUIII _ l I O N ... 10 IPKE 1'OlJR DfQ88ICIN, _ lJIClI( FOWARD
TO._ WI1H ON 11118 PIlOIB:T AND IIGPE lIIAT rr WIll. COME AIIOtIT. If lOU IIA\, fIN( OIlIER
CllBI10NS A8OVI' tHIS 1NRIIIIIA1IGN PI.EA8E alNJAQ WAIIIIEN aAU. oa IIlY&EU AT EXm/IIa\I
U3I.

60 'd sss 'ON XII~ II IIlJ ~S: II 3IlJ. LS-oZ-AVil

 86

PmEPIGHIER as -, .
I. PRINCIPAL DIlTIES AND BESPONSJBU,rrq;s'
This position iDYolves sbift work; fifty-six: (56) boars per wecIc on a
rotating basis.

The incumbent serVcs u a cfmw-operator of~ fireIisbIing WbicIe:s to combat fires in

residences, hospital and oBice 1IuildiDp. warehouse, fi1eI storage areas, shops, bNsh and 'WOOded
areas. Helme drives vehic:\e scene offire, fullowiD& ~ route or se1ectmg IltaDaIive
Helshe positions ~ wiIh respect to wiad direcrioll, watc:r IICIUROC, potenIiaI haDrds. Tbc
incumbent operates pumps, fOam geueraton, and -equipmeDt, detenDining and monitoring pressure
needed for distance to be pumped aDd DIJDIb.. oflinea used. Helshe monitors WlIter IIVds in
self-contained tanks and warns hosemen and rescue_lI:when 'IVlIter is low. Hcfshe pedOlIII3 daily
preventive maintenance inspections ofvehicles and equipment, per1bnning opcratllr maintezwlce.
Helsbe assists in training otber fire6ahters in cIrMIJa ud opcrUilla equipmeIIt. Bcfshe acta a
. rescueman when not opcrming vehicles and uses fiqt lid skills to assist injuRd victims. In the
absence of crew cbief.s, may act as crew chief durin& appropriate shift, keeping log of activities and
making incident reponson abnormal oc:c:urreIIUS. .

The incumbent pcdbnDs advm:e fire proIedion inspeQion throughout ~ bospitalfur violations of
tire regulations and for potential fire hazards. Helshe inspects cIemic:al systems and equipment,
flammable materials, .storage, oxygen and compressed gas storage. cliecks fixed protected gas and
equipment for proper placement. Helme participatcs in investigating causes of fires by inspecting
damage. Helme conducts uaining fur firefighters and other sution employees in firefightlng and
fire protective methods. .

The incumbent in addition to fire and fire safety re1ated duties, may be assilioed as a member of the
water rescue crr:w (boat) or the Emergency medical m:sponse VIllI. (ambulance). In either case, helshe
will function as a team. member'to accomplish the mission u necessary.

The FirefightcrlEmergency Medic:al Tec1mician wiil be a clinical member of the Emergency Response
Team. His duties will consist 0( but at a doctors direction not limited to, the following:

The EMTs employ an sources of infonnation in order to determine the nature of the persons illness
or the extent ofhis injury.

The EMTs survey the siclc imd injured person and establish priorities for =Bency care.

The EMT's render emergency can. They establish and maintain an open airway; they ventilate

Ol'd S55 'ON XlJ:I \I IIIJ 55: \l 3/ll L6-0Z-AI;II/

 87

nonbrealhing patients aad admiDster c.rdio PuImoIIary~ wbeiI there is a fi1I1 c:ardiac
mest; they COIII1'01 hanouha&e mI draa mI beda&e WOUDds; they treat tM pIIient 1br shock; they
immobilize IDctures; they care for mecIicIlaDd envirollDlell1l1 cmergeades; they l!PiI~
Ihe.y ca:e fOr madaIly diIIurbed p8Iieaa. ~ properly cpIi&d!bey d~fIh'! pa,an'6thcr
advanced life IIJPPOrl opcnIioaa UIIder the cIinc:ticm ofa physidm (DDt to _ _ his qualification
level)

The EMTs reassure the patieDr.; Rbtives aDd bymDders by workiDg in a coafideat aad emc:ieat
manner.

When accident vic1ims nmst be ~!-om Clltnpmeat, the EMf. use pracribed teclmiques and
tools to remove victims quicldy and safely. They pc:di)rm basic rescue operations if other 6refighters
are not on the ~e; ifsueb. firefighters.are pnMIIt they care fOr and pivtect the vic:tims during the
extrication operation. After extrication is !llX:Qlllpiished, they cont:iaDe cmergmcy care measures.

The EMIs traasfer the pIIient to a stretcbc:r, secure aud cow:r him IDd load the stretcbc:r iDto the
ambulance. When neceauy, they employ special akiIb in ~ patiems to the ambu1anee.

The .J;MT operates the ambuIaDc:e in a JDIIIIIer IUCh that die pGieaIs physical. and emotioDal condition
is not womnecl, u by _rough, swening ride IDd the IOUIId oftbe ana.
The EMTs COIIIIaIItly observe the palieat wbiIe CIIItIUte to the medicalliu:ility, administering
additional care u indicated or at the cIiredion oftbe phyIiQan.

The EMfs record cbangu in the patients viDl signs cIuriDa transportationto the medical &aIity; if
under the direct care of the EMf this iafbnna%ion will be pracntod to the emergeII"Y dqlanmatt
physician upon arrival. -

Upon arrival, the EMfs lift the stretdIcr-bound paticat iom the ambuIaDce and transfer him to the
emergency deputment.

The EMIs report verbally and in writing their obsenations and initiI1 care of the patient 11 the
emergency ~ to the physician, ciwJ&es in the pltient's WaI .signs during transportation IDd
continuins care provicIed while enrvute whea.uaderthe cIirec:t eIi8 of the EMf.

The EMT tnnsfeq the paIieat'. penonal eft"ecQ to m emezpnc:y department stafrmanber.

Fonowing completion ofthe call theEMrs will:

. -R.cpIace u.d Jiaens and bIuIbts
-sanitiz the ~.and suppliea
-lleplac:e expendable supplies
-Check the ambulmce inwDtory for oompletmas
-See thI1 the vebide is serviced
-Tab penona1l11fec:tion Control measures u nquired
-Complete required records and repotU

I\"d 555 'ON XIJ~ II J.I\/ 95: II 3Ill L8-0G-.\W

 88

-Critique the emeqencylUll with peers

n. CQMPEmNQB$"

Demonstrate the lawwledge uul Uilityto meetNPPA 1002, Driver Opcntm Professional
Qualification StaDdards uul to drive IIId operate a motorizocl fire appu1IlUS.
Knowledge ofIuul ability to perform firemaIic datia that require the use of ropa,ladders,
hose. wam- steuD; fbam, salvage lad owraD rescue, water suppliw, IpIinIden, ....inl";sber
ventilatiOJl, haz-mat, forcible entry.
Knowledge of life savings apparaIUS and ~ equipmell1 that USURa maDmnllllCe lAd
operations do not compromise the safety of patiaIIs stat!; Witori, gowmDleIIl property or
the enviroameor.
Knowledge oftrainiD& ~ mil rcgulatioas for all new IIId cXistiag employees
ensuring that the safety educ:m-t needs Be mcceafiIIly met.
Xnow1ed&e uul ability to ~ tnlning episocIcs.
Knowledge ofMedical Caller sa&ty propm.
Knowledge offand ability to pI'CRIIt IDd cIIIIIOustnle fire ~ IDd educaIiOD prognms.
Knowledge ofFue Alarm lAd commnnications systems lAd the ability to identity problems
with same. .
Knowlqe ofF.C.C. and V.A. CCGIIIIIIIIicII procedures, regulaliODS, and proper radio
protocol..
Knowledge ofNFPAFJfe Codes. OSHA.Standardi mil VAreguIations for impIeaIemation
of prograa:l and ia3pec:tions thai __ compIi.mce. .
Knowledge uul.abiIity to test aud iuspeet smoke detecton, aprinlder. exliDpisher.
Ability to ra.d and inIerpnt pre-fire plans and bIuepriDU.
Knowledge and ability to prepare approprilte reports and doa_atiO!! to ensure c:omplimce
with all codes, standards and inspections.
Demonstrate a basic knowledge of the equipment c:mied on the ambulance IIId the abiIi1y to
operate" maintain the IIIIbuIaIIce acc:ordinc to NYS DepartmIIIt TnnsportationE.M.S.
standards.
Knowledge oflnfectioD. CoDtnJl staDdarda.
Demonstrate the ability to ensure that all tiRfiahters use.proper protective equipment uul
follow safe work: practices It aD times.
Knowledge to prepaR a pre.pIaa. far a smu. tIIIpt hazard, usiDg foails SJIIIboIl, and maprl
blueprints prescribed by the autbcIity bavlacjurisdidioD
Ability to prepare an optrIIional pIaD 1bat idadifiea the required.-ces mil safety COIl-
siderations for the safe uul succea6J1 co.atro1 of an incident.
Knowledge of safety poJicies aDd infection c:ontioI poIiI:ieL
Demonstrate the ability to display tII:t and courteIy in aD ccatacr& with pIIiems, employees.
and the general public.
Demonstrate the ability to CO",",,'Mte onDy IIId writiq.
Knowledge of uul the ability to CODIIIIJIIiCltea -tina rdatioasbip with, local, county. illite
. and other Federal Agencies as maybe required to tiI:iIitate iDter4pllC)' coopetItioas uul
coordination ~ both normal aDd emageacy si1uatioDs.

Z\'d 555 'ON)(\;I~ V 11\1 95: \I 3lI.L LS-OZ-AVII

 89

m SIJPERVlSQllYCONIROLS'
The im:umbeItt is WIder immediate supervision oftile shift CR!fIII ~captain IIId pnenlllllpVilion
of the FIre Cbie llou%iDe duties receive 0DIy spot cbecks. SupeniJor gives guidaDce 011 difticuh
problems repnIing c:orrecIioo. offire II1i:ty bazInIs, IDCIbocIs ofopenIion, ete. :rM iDalmbcat while
pertbrming his emergeocy malic:al duties will be UDder . . .upervisioa oCtile cIo<:tor who writ~ the
truISfer order. .

IV. O"\"BEllSIGNJEICANTFACIS'

i. The Flfdigbter works on a rotating sbift. Rellbe is ezpected

always be IIC&t in appearaDQe aDd must be coaiteousat 111 limes:

b. The incuIIIbeDt works WIder severe CODdiIiOllS c:IuriDi adual fire

sItuatioDs, so belshe must meet DVA aDd OPM firdiaht phyIigal stan.

c. The in<:umbeat is RIpODIible fOr all mattcn pertaiDiDg to the

])eputmeat (AmbIa Crew CJief) when the cmv ChittIDd Fn Chief are DOt
couauready on dilly. .

SSS 'ON XII.:! 1I JAI LS: I! 3Il! LS-OZ-A\III

 90

STATDIBIIT 01' KDI1fftK T. LYOKS

NATIOIIAL _IDDT
lIATIOIIAL ASSOCIATION 01' ~ IDIPI.OYDS
OVDSIGRT AIm IlWUTIIaTIOirS ~n
HOWE VftDAIIS' APPAIllS CCIIIIITTD
KAY U, ltt7

JIlt. CllAIltIIM, IIEIIBDS 01' TIm SlJ8CQiiilUU I .~ TO TDlIIt YOU

FOR THIS Ol'POJlTt1laTY TO PLACB THIS STATDIBIIT Dr TIm 1tECOJU).

'l'IIZ lIATIO~ ASSOCIATION 01' _ _ IDIPI.OYUII (JW;S) IS All

. APPILIATB 01' 'l'IIZ SDllICB IIIPI.OYUII IIITIlIIIA'lIOIIAL UJrIOIr, 'l'IIZ TJIIJlD
LARGEST 1lWlON IN TNE Al'L-CIO. NAGI: IlUItBSDTS OVD 120,000
IIIPLOYDS NATIOIIIfIDI DrCUJDIJIG OVO 10,000 IN 'l'IIZ VftDAII Al'l'AIIlS
DEPAJl'1'IIIIIIT

IT IS JlY UllDDS1'AlmIIIG THE AllBRICAII rBDDATION 01' GOVKIIIOIBIft'

IDIPI.OYUII (AFGE) 1IJ:LL BI TESTII'YDIQ _ I N e ; I'XU SAFETY ISSUES ON
IIB1lAL1' OF TRE FIVE LABOR ORlaNllA1'IONS WHO JlEPRlSIIft' DEPAJl'1'IIIIIIT 01'
VET_S AFFAIRS FIRlI'Ie;II1'BIlS. II_USE 01' TDm 1lUTRAIllT8, I WILL
FOCO'S MY STATDIBIIT ~ DIIPAImmII'l' OF VETDAIIS APPAIRS POLlCB
OFFICBItS.
RlCIII'l'LY, C:ONGRBSSIIAIf SOli I'ILIID IJITROI)UCW B. R . 1215, A IIILL
TO PROVIDE LAW IIIIFORCDIINT S'rATI1S TO INS AND CO'STOIIS INSPIC'l'ORS.
OILS JW;S SI1PPORTS THIS IIILL WE IIBLIEVII THAT DEPARTJIEII'l' 01'
VETERANS AFI'AIRS POLICB OrFICDS, SDIP G8-013, SHOULD III: INCIoUDBD
IN THIS BILL.

AS WI: ALL DOW, SAFftY AT VA FACILITIES IS A1f I:VD INCRlUIJIG

PROBLEM . MANY ARB IN HIGH CRIJII: AREAS WRDE POLICI: PROTI:CTIOir IS
CRUCIAL. 1'HB DIIPARTtIBNT 01' VftDAIIS APPAIllS (OVA) POLICE OI'FICBRS,
DO A RI!ICAltKABLI JOB SAFE GUARDING TNI! PATII!NTS, VISITORS AIm STAFF
AT VA HOSPITALS AND IIBDlCAL CEII1'DS AeRO.. 1'D COIlNTJlY. TRUI!
POLICE OFPICzas ARB AI1THORIIBD TO KAJa: AllRl:STS, POS8U DBTD'nOM
POWDS AIID MOST ARI! LIClIIISBD TO CARRY A lIDPOlI. III OTND !lORDS,
TRESE POLICB OFFICERS RAVE TNB SAIl!! RESPONSIBILITIIIS AS FOLICB
OPFICBRS III ANY CITY OR TOlIII IN THE UIIITI!D STATU.
ct1ItREIfTLY, OVA POLICB orncl!RS POSSUS TNB sm BLIGIBILlTY
RIQUIRIMI:II'1'S IN TN!! RETIR'IIII!NT SYSTZII AS HOST I'BDDAL EMPI.OYUS.
TNBSB DBDICATBD OFFICERS DI!SERVE TO III! DBFDIBD AS FBDZRAL rAW
ENI'ORCEIIBIIT OFFICERS AND ARI! I!NTITLED TO ALL BENEFITS UllDER THIS
DESCRIPTION. RlCI!NTLY, I RlCEIVSD A LETTER J'IIOI( RZPRUI!NTATIVE 80B
 91

I'ILlfD SUPJIORTIMG 'l'BIS IS511I. I WOULD LID TO SUBKIT 'l'BAT LZ'l"l'D

FOR 'l'IIB ltBCOItD. I IX ALSO PLJIASID THAT AFGB AND '1'IIB lfA'1'lOlfAL
I'BDIRA'l'IOlf OF I'BDDAL DIPtOYUS ~ 'l'HAT OVA POLICZ OI'nCDS
DZSDVB '1'0 81 DBI'IlfBD AS nDDAL lAW ElflORCZImNT OI'FICDS.
MR. CHAIRKAlf, WHILE GIVIlfG QUALITY REAL'l'H CARE '1'0 V&'l'BRAlfS IS
'l'HB PRlORITY AT '1'HE VA I 8lLIBVI THAT THE SAnTY OF 'l'BE FACl:LI'l'Y IS
EQUALLY Vl:TAL. WE NUST RBCOGNIZE 'l'BI: IfUD TO ELEVA'l'I 'l'II& STATUS OF
'rHB OVA POLICE OFFICER SO WE CAN RB'l'AIN AND UClWIT 'l'IIB BUT
POSSIBLE OFFICIR AVAILABLE.
 92

Hospital
Shared _~_

Services================================"'=~=~====
May 19, 1997

Mr . Ada. Sachs
U.S. Hous. ot Representativ
333 Cannon
Waahington, D.C. 20515

Dear Mr. Sachs:

It vas a pleasure to talk with you today reqarding the
propOsed arainq ot VA Police/Security peraonnel. Based upon the
incident you related 1n Jackeon, Mi issippi, it is appropriate
that ~1. issue be reviewed.
As w. discussed, I believe it is necessary to look at each
facility on an as needed basis, verses a "blanket" of arming all
facilities. This creates numerous problems including the
lection , retention, training, retraining, competency, and
effectiveness ot the security personnel involved . Also, since the
VA i . part ot the Federal Government, consideration would need to
be given to consiatent training with other comparable agenci.s.
In ay opinion, the need to ara .ecurity personnel should be
based on a site specific needs asses.ment. These assess nts can
be conducted by using a multi-disciplinary task force or by outside
consultants. If outside consultants are used, healthcare specific
expertise in various sizes and types of facilities should be
mandatory . I personally utilize a wide variety of criteria in
order to e.tablish what constitute. a reasonable and appropriate
security proqrall for a specific health care facility. The
folloving list denotes the standard areas ot review. I then use my
experience and experti.e to develop recommendation

Security Proqra. Organization Overviev

security Vulnerabilities/Risks
Security Functions and Activiti.s
Security staffing and Deployment
Security Cri. . Prevention Activities
communications/Physical and Electronic Security
Security Peraonnel Training
Security Staff Development
Security Policies and Procedures
Security Record. and Reports
JCAHO Environment of Care Security Related Issue.
OSHA 13148 Co.p1ianca
Ancillary Areas as Necessary

27J'-,.....~~~
1395 SOIAh _ _ _ Driwt 0.-. CoIcnIdo 80223 (303) 722-5568 FAX (303) 733-0253
",... .........0
 93

Mr. Adam Sachs May 19, 1997

U.S. House of Representatives Page 2

I am also sending you, via Federal Express, a hard copy of

this correspondence, a copy of the ASHE Technical Document #055134,
and a copy of Healthcare Security Manaaement: Handbook for your
edification. I hope this material allows your committee to ask
appropriate questions during your hearing.
If I can be of further assistance, please contact me at (303)
722-5566 .
Sincerely,

Fredrick Roll, CPP, CHPA

Executive Vice President - Security
 94

Hospital
Shared ~.flespoNNe_
Services================================"=~=~==~
CREDENTIALS
FREDRICK G. ROU
370-52-8070
CERnnED PROTECTION PROFESSIONAL' 2618
CEBVFIBD HBALTHCA.BE PROTECVON ADMINISTRATOR 'NOO55
CBB77FlED S6CURTTl' BXBCl/TlYE IfIDltH
CERnnED 8BAL711 CARE SBCU1UTY EXBCllTIYB IOOlfHHC

mUCATION A.A. Degree Mott Community College Criminal Justice

B.S. Deg .... Eastern MiChigan University Education

- Sociology
Post Graduate Work University of Detroit Security Administration
M.A. Deg.... Webster University (Denver) Security Administration

EXPERIENCE ~
Executive Vice President- Responsible for security services in over 100 hospitals
Security Services nationwide.
Healthcare Security Services
1395 S Platte River Dr
Denver, Colorado 80223
(303) 122-5566

Vice President,
General management of HealthCare Security USA ,
General Manager
providing high-quality security services exclusively to
HealthCare Security USA
health care facilities, nationwide.
Atlanta, Georgia

Police Officer Eastern Michigan University

Deputy Sheriff
Security Supervisor
Director, Campus Safety
Director, Public Safety
Director, Safety and Security
Director, Security
V. P . Consulting Services
Washtenaw County (Michi&an)
University of Michigan, Ann Arbor
University of Michigan, Flint, Michigan
Hurley Medical Center, Flint, Michigan
Baptist Medical Center, Jacksonville, Florida
Hospital Shared Services of Colorado - Responsible
for 400 security officers in SO facilities
throughout Colorado and Wyoming.
Healthcare Security Services, Denver, Colorado

27 jI-~'f"~ ~-Y........
1395501AhPtatt.RiverOriYe o..-. ColorBdo1lO223 (303}722-5566 FAX(303}733-0253
........ OI!MqdIM,..,.,O
 95

Fredrlc:k G. Roll Credentials Pace 2

INSTRUCTOR Basic and Supervisory Security - Mott Adult High School

Occupational Health and Safety
Various areas of Security
- Detroit College of Business
- International Association for Healthcare
Security and Management and Safety, International
Association for Campus I:-aw Enforcement, various
colleges, American Society for Healthcare Engineers,
and various healthcare organizations and departments.

CONSULTING Former owner of Roll Enterprises Security Consulting and Training Company plus
SERVICFS various independent projects. Nationally known security consultant.

PUBLIC SPEAKER Dale Carnegie Graduate Assistant. Guest speaker for numerous clubs and service
organizations. Nationally known public speaker and lecturer.

AWARDS/HONORS I.B. Hale Chapter of the Year recipient from the American Society for Industrial
Security (Charter Chapter Chairperson)
Who's Who in Security
Certified Protection Professional - American Society for Industrial Security
Certified Healthcare Protection Administrator - International Association for
Healthcare Security and Safety
Certified Healthcare Risk Manager - American Institute of Medical Law, Inc.

PUBLICATIONS Author: Heallhcare Security Management Handbook

Chapter Contributor "Security Management" The AUPHA Manual of Health
Services Management. Publish date January 1994.
Numerous articles in various professional security publications.
Author: "OSHA 3148: Analysis of Workplace Violence Guidelines" Healthcare
Facilities Management Series, American Society for Healthcare Engineering

PROFESSIONAL
ASSOCIATIONS
AND Member International Association for Healthcare Security and Safety
ACTIVITIES American Society for Industrial Security
American Society for Hospital Engineering (AHA)
Aspen Publishing Editorial Advisory Board of Healthcare Facility
Safety and Security Administration: Forms, Checklists & Guidelines.

Safety and Security Management Committee-American Society for

Healthcare Engineers
Board of Directors - Security Management Institute
Advisory Board Member - Health Care Safety Institute

liil1
President International Association for Healthcare Security and Safety
President Florida Society for Healthcare Professionals
Treasurer International Healthcare Security and Safety Foundation State
Chapter
Chairperson International Association for Healthcare Security and Safety
(Florida and Michigan)
Chairperson American Society for Industrial Security, Flint Chapter
Board Member International Association for Healthcare Security and Safety
President Michigan Campus Law Enforcement Administrators
 96

OSHA 3148: Analysis of Workplace s..;... -

s.t.<y and Security
Violence Guidelines

.........
~
FfWlrickC. RDII
S UMMARY Via PraiUft'~l MInttIger
H.lfhCllre 5tctlrity USA
OSHA h.. dtlldoptd gulddllltS tlrat.,. th' agmcy'. UUidon,CO
m:ommmdtltions for rtducing workplace violence,
sptrifiatlly in Ilrt harltlr azre lind !OCW-5m1ias rrott
enviroruntnts. ThtH gl4idtiintSlin intended to be UviIory
in rllfturt lIS wdl as in{onrrlJtional in Ct1J1tenf to assist
employtrS in establishing" SIIfr workplace by C1ts1ting
t:{ftrlive vioImu pr~tion prognmu. Th~ guidelines
sItotdd II< .std and ad.lpttd to """ th, sptdfic .....u and
......"'" of ",ell pill" of mrployment.
 . 9'1

Healthcare Facilities Management Series

Thehellthcue facilities management _10 a collection of

Sodety.for HeoItIlare EftaI-""

publkallons that are printed monthly. A product of die American
the documents cover 51np topics
Important1n Clntcal/a_1eaI Bn~ Padlities ~
DesIp and eonatructlcm. and Sofety and Security Manqement.

PNIII&Ilt
ChuIoo Budde. FASHE
PnoIden..BIect
WIIIom E. Ooel Howard. SASHB
lixutive DIrector
Joe MartorI
 98

1NTR0DUcnON ________...___ _...__.__.. ___._____ ._____.___...__ ....._..__..._..____._.. __.._.________. 1

HIGHLIGHTS OP 1HII OSHA CUtDELlNES _______________ ________.. ___ .._._ .....___ ____ . ___.2
SIICTION I: 1HII NBBD I'OK MANAGBMENrS
WrI\Wl _ _ ~
COMMITMENT
for lot> Sofety DId Security __ _AND
__ BMPt.OYI!B
__ .______ .. INVOLVBMENT ....:..32
_. ______________
SBCTION D: 1HII Nl!I!D!'OR A WORICSnB ANALYSIS _________ _ __ . _____ .. _.. _...___.______.3
SBcnON 10: 1HII APPUCABIUTY Of MEASURES 1HII0UCH BNGINI!I!IUNG OR ADMlNISTRAnvE
AND WORJ( PRAcnee TO PltBVENT OR CONTROL HAZARDS _....._..._________..._ ....____.__._ .
SBcnON IV: 1HIIIMPORTANCB Of TRAINING AND BDUCATlON POR ALL BMPLOYI!ES _.. ____ .__.5
SEcnON V: 1HII NBBD POR RECORD KEl!PlNG AND EVALUATION OP 1HII PROGRAM _. ____.6
1HII OSHA SJlLP-ASSIISSMENT ANALYSIS TOOL ____.._ .. _. ___.___.____..__..____ ... __.___._______ 6
OSHA 3148 ____ ._____._____________________.__________ .___ ....___ ._______ .____.8
SBLP-ASSESSMENT ANALYSIS TOOL ________ _ __ ________________.19
 99
- 1 -
IN'nODUcnON
The purpooe of lhisdocumenlls 10 _ radon
~~~US~of~~~~W~
mel Health AdmiN_tion (OSHA) Docu..-13148
which became effective March, 1996. OSHA had been
WOJIdngon thtsdoouno!nt Ior ...... _ one!_1OcI
~ uoIstan<:e mel inpul of varlous gTOU~ one! orpnl-
zolloN induding the American HospItal AaoodoHon.
Memben of the American Sodety for HeoJthcare
volved in ~ review one! comment_
EnsI-lI's 50Cety mel Security Conunl_ ...... In-
Asa_1
of these efforts, the guideli.... allow fodJilles, as ""'lOcI
in their commitment section.. to U~ them IS an advilory
mel educational resource 10 be ' used by employers In
providing a safe one! heoJlIUuI workplace IJuou&h effec-
tive violence_lion prognms, adapted 10 the
needs mel .....".,.,.. of eoch place of ornpIoymont'
Due to the tmpact of the name "'OSHA" on. docu-
ment,. many people beHeve that compUance is manda-
tory. The documenl does, however, stress ~I these
guldeUnes are NOT a new standard or reguJ.Hon. The
ratioNl for this document is to make employers aware
of the potential of violen~ In the health. care and ~
daloervices areas and help ~th the developmenl of
effectiyo Violence prevenHon prognms. Also, lor a
number of years emphasis has been placed on the pro-
tection of padenl> wI~ Uttle or no effort being spedfi-
caUy cIlrected toward the employees. OSHA hu al-
ways emphasized the protection of employees, mel
Ihrough these guidelines, specified recommended oe-
don in the health care and sodiI services areas.
OSHA ~U nol cite employers lor failure 10 comply
~th or utilize the guidelines. TheY wiD, however, rely
on the General Duty Clause of the 1970 OSHA Act II
~ Is. nocognized hazard of worlcpJace violence in an
_ . m e I II ~empJoyer hu failed 10 toke oe-
don 10 01_ prevent or abate ~ hazard. Since employ-
ers have. general duty 10 provide an en.............1 thai
Is free of recognized hazards likely to cause dea~ or
serious hann, employers are placed on notice that an as-
oesomenl should be conducted as. proactive method of
proViding a safe enVironment This .....men. will al-
low properly ITained and educalOcl incIlVlduaJs 10 iden-
tify polential risks one! vulnerabilities one! mske reason-
able and appropriate recommendations. nus can be
done on a Iocallevet or if necessary. with the usis--
tance of. certified health care security professional.
HeoI~ care fodIIlieo wI~ tfftioe IOCUrity........-
.......1 programs under ~ Joinl CommIasIon'. envbon-
mont of Care oecurIty, relalOcl 1IIaNIanIs, wID find that
they havealn!ady addressed a nwnberof ~ .....
dlOcl In ~ OSHA guldelinn. FodIIIIes In CaUlorNa.
lor _Ie, wiD also find ~I tile OSHA guJdellneo
~e1 CaI.()5HA mel _ I y BiD 508.
The guIdeD........ perIormance-bUed, and ~....",..
mendaIIonowOldifler_ upon a haDrd anaIysioof
each /adUty. The guideD.... ""'te. "V1_1nIIictod
upon employees may come form many """""" tnd..d-
ingpstienls, thin! ~such .. _ or ........,
and may indude ro-won..n. Theoe guideli.... only ad-
d.... violence inftlclOd by ~tIen .. or clients opInIt
~ stoIf. The princlpl", however, .....te a blueprint
one! outline 10 deoeiop a _and~" Io-
Ience prevention program to _ . . . . , - . facility.
The _ _ wOI bed_.bued upon a
huud onaJysls of.,.. fodJlty. The poIldoo, pr0ce-
dures and guIdetines eoIabIIshed ohouId _ ....,
01_
1O_1or violence.' OSHA reaJIzeo thai nol aU ind-
dents can be prevented. However, many can
prevenlOcl or mldgolOcl with appropriate _ I > ,
be
by lmpIemendngreuonable ~ and physkol
controls, troinlng of slaff and monllOring of Incidents
to continually improve the prograrn.
Accorcllng 10 ~ B.....u of Lahor Staijllllc:s data for
1993, heoI~ care and >OdaI aervIce workan have ~
highest incidence of ....utl injuries. Abnoot_
of non-Isla! ....utl> occurred In nUt!lng homes, hoop\-
0_
.... one! ....blishmenl> providing residential care mel
>OdaI services. Studies conducted by tile interna-
tional AssocIation for Healthcare Security meI~,
the Emergency Nu.... AaoodoHon and the Emergency
Physicians A_lions have alii_lOcI violence as
'~I_. n-lsaisoCOllmabouttlle_
reporting of _ _I> which prompted CaIIfonU
Legiola_ Assembly Bill 508 10 malldate ~ reporting
of _ultivebeNViorone! ~ IIIIddng of .... _
HeoJ~ care and >OdaI aervIce workan face an in-
creased risk of work-related ....ull> stemming from
several factors:
Prevalence of hand guns anctolher weopono In
society
U.. of hospitals by poUce lor criminal holds
 100

-z-
CueolllOdolydloluJbod _ _ _Wl_
Core 01 montaIIy W paIIoft..
AvoIIobIIIty 01 cInIp. _ _ ouppIJoo 1ft ....
An~tealloca_oI . ._ t y _ ..
_ .. aD ftIPONIbIepo.-.
. -hoopIto!-.
. . . 0 1_ _

Drus - oJcoboI .......... Asy-..oIaamm1ab1l1tyforInYOlved ............

'J'raumapatien... ouperoIIon-~
~uptfamlly_
Domestic vtoienc::e CUfS A CD1IIpIOhoNIve .......... oIlMd1co1_ """"'"
top:oJ COUMOII.. _ cIebrIIIInf for...,."..
......-
I'rustradon due II> Ions ......... ""-aen<Y

IooIaIod workll. .
expeIonc:II1sor - . .. . . _ _
_Inddents.
lMtt 01 ................ _
I n _ t o ! oocurIty - . I.e., poor ...........
potonIIaI hIcIIns pIoao,-

II-. ...,aepollaoo--_.. .,
""' _ _ _ .CXlpyol""pIde-

_ _ _ _ _ ......
aMIyoIalDOLlIy....tJns- ~
IheIDDl....,."..
.... -
ad
A

--
_
_
_ I .. oupport_.........-~
prtato_fromoafoty

EmpIoyeelnvol _ _ _ _

_1__.
__

.......... dowIop _ _ lhelrown

.. ooloty _ _ th._ povIcIa
cIoIIp, iqIIoInonl_
wWbeable .. _lhelrr.dlltiOO_work .... - .
monll,ldontIIy poeentlallluudl, rtob _ vuInor- evaluate the pogrom.
abIIIIIot._cIewIop _ _ ~..,.

"""-'dona for c:orrectI... _ ~ _ B~In"'I_' _ _ ""foIlow1nt:

___ be_by""_~for

applicability baled upon the.- _ _ .1 An uncIentancIIng _ CIOIIIfIIIo- wlth .... _

_ _Ity_workllte. p\I<>o-prnendon popm--"""If
andoecwlty_
IUGHUGHl'S 01' THB OSHA GUlDBLINIS
~'--wUlbe~cxnoortns""_
tnsft..._~ _ _ _ om- portldpatlon III ... ......,.. """'fIIaIntat
........ procedw-e covert,. ooloty_
pIoyte lllvo1_ work lite ana\yIII, -..to 1ft" oocurIty- .
. -- c:onIIOI.lrIlnInc _ educatlon._
noon! \<eePI'I- entua_ 0I1he pogrom.

SIICI"ION I: THB NIII!D I'OIl MANACIMIIN"rS PutIcIpa_ 01\ oor.ty and _ _ _ _ at

COMMl1"MIINT AND IIMPLOYIIIIINVOLVBMIINT
ManopInonI'I_tment_ ladade Ihe_
~t _ _ lnvol_tollDp""""'"
mont. povIcIe for IheJllOtI..tIon _ _ II> cIooI
etroctIwly with worIcpIo<e violence, _ _ In-
clude the fo11owlntr-
_lhetreoolYereportaol _ _ _
oecurtty probIemI, mob - t y 1nopedIona_
respond with recommondatlono for propooed
conec:tI ve slnlloIiH-

A
~ __.ted conmn for
_ phyllcalooloty
OIpIIIzatIonoI _ _th.
Talclngport In. conbut.. education pupom
thol_~""""SJIIze-tt,. .....
lotion, ....uldve behavior, or crImInaIln....t. and
_.ppoptate_
An uotsned raponoIbtIlty for .... _ _ upecto 01
the WOI"IcpIace violence _don pI08I"IIIft 11>_
-..thotall ............ ~_...,."..
.i&_C:;",_=:::J
OIIo-AuIoIIo.CIoIaoto. _ _ .. _ , = _
 101

- 3 -
_lion
W'-""'-PlopoIafor
Ie SoIety--1F

_t
A wrt..... propam for job IOIety _ - t y nealslo
be Incurponlled liiio die ~......... 1OIety
_ '-ItIt propam .nllt door poll _ oIJjoctha 10
---_.+_._--.
workpIaoe vIoIonce _ .

----.--.......,.-.
.-uta!I_.
of die
.ppropria.. _ _ _ lObe ....... The_

oa:upationallOlety _ '-ItIt.1epI _

-.
~.

die _ _ worIcpIoce violence.

a>mpIedty nealslo be
of dieItwm.pIo<e _ suitable
_ _for die human

__

_lion ~------.....
beodoptlblolO~lI_in

claims should b e _ 1 O 1dentIIy.,.-0I

The propam _ lllltup cIa.. . . - be _u1lSlIlat could be prevented by wortpIace ad-

pi* vIo""" _lion

communlaolled 10 aD -..!oyfto. At a minimum, work-
propamI ohouId do die f0l-
aplalicm. proceduraIchangw or empIo)'W nwng.

The-.._.....,.._tndt ........ _
lowing:
-..anaIyso~ ....... ....,.-.....,...
Crute and diAeminate a door policy of ...... wortpIace - I F prooedures.
,...".,. for workP- vtoIen<e. - _
non_ _ IS. and .....1Ied acdona. _ S _ _ whicltprovlde~wIth.
q-"or_loptlhok_OI\dIe~
tent1aI for _ _ ohouId be dneIopod 10

_Ie_ --
E_lIlat no reprloal. are token ogainot an
.......,.whoreportlor _ _ _ ~
IdOIItIfy .. ~ dIe'- for I""""",, ooc:urIty
vtoIen<e.

_-,om"""lo~repoIt_
10 ougest ways 10 reduao or
_ _ _ ohouId be cond1actocI
aDy or _ _ dons change or inddenIo of
at_.....
workpIaoe vIoIonceocx:ur
prevIowIyunnollcell _ 10 hoIp
_ IdentIIy
___ .. ..
OutIine.~..,pIIIn formainIainInJ
IOC1Irity in die workplace. whiclt incIudes..- /oJ....... in work practIcs, procedurea or con_
....... IIabon.nlltlaw_ .........
Ii_ Sa/ety--..-.-.. -=urilyopec:lallolo
_ other qualified penons 10 oIIor advla! 10
- . - _ ~experts""canprovldo
Aootp rapoNibIIity and .uthority for the pro-
pm 10 Individuals .. _.nllt .ppropriate
Irainlng sIdIls.
fresh perspedi_1O bnprove
prosram.
.to....,._tIon
AIflrm manapment. c:ommItment to. workJer.. A workplaoe -.rlty analysis ohouId be cond1actocI
aupportIft OIIvI..,........t IIlat places as muc:It
importance on empioyft IOIety _ _ lit u on dldons. _dons _
10 .....uate employee'tub 10 IdOIIlily haurds. con-
lltuatlana IIlat a>U1d lead 10

_t_
-.lng die patient or dionl vtoIen<e.

SIICIlON D: THE NIID JIOIl A WORICSrrB An analysis of Inddonts should _ d i e chane-

ANALYSIS _ o f _ _ -""anaa:uuntofwMI

_urn. .
The following are suggestions ulo how 10 perform..t
worlcslle....."...
happened before _ during die
movant cIetaDs of die lltuallon _
die
ilS o u _.

A_oIopecIfIcproced....... .."...donslllat /01>0 or Iocadons.nllt die srea- risk 01 vtoIen<e

contrlbule to haurd. _ specific locations _ should be 1dentIIIod.
haurd. may develop.

An _ from individuals of die potendallor

A_Io...,....._""" .. typaol_
or patiOlllS (dilorlelllled by drugs. alcohol o r _

_ _ ao...,. _ _
o...
_-s.x...,C_ ..........",doo_HoopIoI_
 102

_ o f .... buildlng.Ioo..1ed Ioca~job_ Provldtna COUNOIl". or potion. core roo.... with

..... 1IsJ1IIa1I ~ Iod: 01 phones _ other two ext...
mmmunicaIIoft devkeI. __ of..." ...-..red
....... _ _ whllpomou. _ t y pnIbIomI 11Iefollowtne: _ _ f o r _ h e _
Ihoulel be noIOd. work proctIce controls:

11Ie _ _ of eJdatIng security monu...

--
Administrative _ work pnctke amtrolllhouJd
IhouId be evalualed 1ndudIng"""-". control ..... dearly ,.,po..... _ .. _emp~tha.
YIoIence it not ponnItted or ,.,....ted.

SIIClIONID:11II!APPUCABlUn'OfMEASUIlES E~ IhouJd be required ,., ftPOrIall_uJlt

11IROtiGH ENClNIIDING OR ADMlNlSTIlA or _ .. to. aupervilor or 1lIOROp.
11VI AND WOU: PllACIlCBS TO f1t1!VllNT OR
CON1'IlOL IfAZAltDS MaNgement au"""rt IhouId be provided during
~ n-Ihould be _ l e d for opecIfIc oppIbI>iI- emergend...
.__ .ppropria_ .
I t y _ upon .... work ... lNIyIIsond for .... _ _
ach indlvldual ...). 'Ihore Ihoulel be. traJnod _
,., omerpndts.
...... ,., reopond

~for~_troIa_ worIcP-
adaptalmlncluclo: Properly traJnod _ t y offtcen IhouJd be uoed
_.-ry,.,deI1 wlth~beha_.
__
RemoYing ...."
.... haurd _ _
- .... or aaIIns
.... haurd.
-'cpIaoe
_11. ._ tImoIy Informatioft IhouId be pr0-
vIded,., _ _ waJtIne: in line or In waltlne: IOOIIIS.
iNIoIJlng _ resuJarIy moIntolnlng aIorm 11)1-
_ other _ t y dericeo, park bullont, hond-held VIIItIne: boun _ proad..... 1houId be onforcod.
_whore rIJk it .........L
A..-oontroI for .... """, focWty _ _ _
ProvIdIng..-1 cIetecton <_led or hondheId) _1hOUJd be carefully evaluated.
whore .pproprIate. aocordiJ1S"' .... ~.
lioN of artIfied hoa1th care _ t y conauIlan... I!q>Ioyeeo IhouId be proIIf1>iled " - wmIng ......
In _ _ _ or walk-In dInks, portIcuIarIy at
nipOt _ _ _ II unoYaiIabie
tIIIne:. doood-drcul' vtdeo .-.ding for hJsIHIoIt
.,.. on. 24--hour beals.

I!ncIooIngnuning - - a-IIngdoop""'"
Coun_orbu_.or ....~gluain
reception ....... trtoge. admitting or d ..... _
_or
11Iebeha_ hiIIoIyol ..... _ _
po_1houId be evaluated ,., 100m about any Put
_u1t1... behalon.

roomo. Contingency pIaN IhouJd be developed ,., _ . dl

..... wiIo -"adIne: out" or rnoIcIne: _ or phyII-
ProvldUla ""'I*>Y- with
during anergendeo.
".Ie..,.,...... for_ cal attacb or tlveatt.

Staff - . . should be ""'~ wlth_ty

Botab_"."tiJne.out" or _ _ ....... _ , . , porldng ..... "'ewnlnsor Ia.. boun.

to _comfort_
Providing woItIne:...,.,...
dIent or potion.minimI .. _ cIeIIpId
1'orId"._1houJd be hfsNy..-. _-II~ and
be oafeIy _ , . , .... building.

A poot.lr1dden. reop:>nse plan shoUld be dewIoped to

provide for. ~.. _ for victimized
 103
- 5 -
employees and employees who may be traumali2led
by witnessing a workplaa! violence inddent.
Home health care providers, social service workers
and others should be encouraged to avoid threaten-
ing situations.
Policies and pro<:edures covering home MeIth care
providers such as contracts on how visits will be
mnducled. the presence of others in the home during
the visits and the refusal to provide services in a
cleuly hazardous situation.
A daily work plan Cor field staff should be estab-
lished to keep a designated contact person informed
about workers' whereabouts throughout the workday.
SIICDON IV: nil! IMPORTANCE OF TRAINlNG
AND EDUCAnON FOR ALL EMPLOYEES
The Collowlng are recommendations Cor staff training
and education programs:
All employees should understand the concept of
"universal precautions Cor violence, which means
that violence should be e>cJ*Ied but can be avoided
or mitigated through preparation. Staff should be
instructed to limit physical interventions in work-
place altercations whenever possible, unless there
are adequate numbers of staff or emergency response
teams and security personnel available.
Employees who may face safety and security hazards
should receive Connallnstruction on the specific
hazards associated with the unit or job and facility.
The training program should involve all employees,
including supervisors and managers. New and reas-
signed employees shouJd receive an initial orientation
prior to being assigned their job duties in potentially
hazardous areas.
Qualified trainers should Instruct at the comprehen-
sion level appropriate Cor the staff. Effective training
programs should involve role playing. simulations
and drills. The competency and performance of the
employees shouJd be demonstrated and documented.
Refresher training should be provided to employees
annually.
o 1996_SodotyforHooIthca.. EngiMoriagoithoAmodconHoopllol_
One North FronlcUa, Cldcago,lIJlnota_
The training should cover IDpics such 85 the facilities
workplace violente prevention policy.
Risk factors that cause or contribute to usaults
should be covered.
Early recognition of escaIadng behavior and rec0g-
nition of warning signs or situations that may lead
to assaults should be identified.
Employees should understand how to prevent or
diffuse volatile situations or .ggressive behavior,
manage anger and how to appropriately use medl-
cations as chemical restraints.
infonnadon on multi-adtural diversity to develop
sensitivity to rac:iIoI and ethnic i . - and dilferena!II
should be reviewed.
A standard response action plan Cor violent situa-
tions, Including availability of usistance, response
to alarm systems and communication procedures
should be explained.
Employees should know how to deal with hostile
persons other than patients and clients, such 85 re1a-
tives and visitors.
Progressive behavior control methods and sale
methods of restraint application or escape shouJd be
taught.
The location and operation of safety devices such as
alarm systems, along with the required maintenance
schedules and procedures, need to be known and
understood.
Employees shouJd also know ways to protect them-
selves and coworkers, including use of the "buddy
system and the polides ~ procedures Cor report-
Ing and record keeping.
Supervisors and managers should be taught that
employees are not to be placed in assignments that
compromise safety and shouJd encourage ~
to report incidents.
Supervisors and managers should learn how to
reduce security hazards and ensure that employees
 104
- 6 -
receive appropriate training.
SUperviSOIS and managers should be able 10 rec0g-
nize a potentially hazardous situation and be em-
powered 10 make any IIeCI!IMl)' changes In the physi-
cal plant, patient care treatment program, and staff-
ing policy and procedures 10 reduce or eliminate the
hazards.
SecurIty penonnel need specific training from the
hospital or clinic, including the psychological com-
ponents of handling aggressive and abusive clients,
types of disorders and ways 10 handle aggression
and defuse hostile situations.
1be training program should also include an evalu-
ation. 1be content, methods and frequency of training
should be reviewed and evaluated annually by the
team or coordinator responsible for lmp1ementatlon.
Program evaluation may involve lllpervtaor and!or
employee interviews, testing and obsel"vlng. and! or
reviewing reports of behavior of Individuals in
threatening situations.
SEctlON V: THE NEED FOR RECORD lCI!I!PING
AND EVALUATION OF THE PROGII.AM
1be following are recommendations for record keep-
ing and program evaluation:
Records of Injuries, illnesses, accidents, _ullII,
hazards, corrective actions, patients' hIsIorIes and
training. among others, can help identify problems
and solutions for an effective program.
1be OSHA Log of Injury and IIIneIs (OSHA 200)
can be used to traclt programming.
Medical reports of work Injury and supervisors'
reports for each recorded _ult should be kept.
Incidents of abuse, verbal attacks or qgressive
behavior should be recorded, perhaps as part of an
assaulrs Incident report.
Information.on patients with a history of put Vi0-
lence, drug abuseor aIminaI activity should be
recorded on the patienrs chart.
Minutes of safety meetings, records of hazud
analyses, and corrective actions recommended and
taken should also be documented.
Records of aU training programs, attendees and
quaUftcalions of trainers should be maintained for
documentation Purjioses.
Employers should evaluate their safety and security
measures. Top management should review the pro-
gram regularly, and with each Inddent, to evaluate
program success. Responsible parties should collec-
tively reevaluate poUcies and procecIures on a
regular basis.
A uniform violence reporting system should be
_bUshed.
Improvement bued on lowering the frequency and
severity of workplace violence should be measured.
Employees should be surveyed before and after
making job or worksite changes, or installing IleCUrity
measures or new systems to determine their effec-
tiveness.
Complying with OSHA and .tate requirements for
recording and reporting deaths, injuries and IIInesees
is essential.
Consideration should be given to using a qualified
outside consultant to review the worksite for rec-
ommendations on improving employee safety.
THE OSHA SELF-ASSESSMENT ANALYSIS TOOL
Included as part of thI. technical document is a Nself_
.-nomt analysis Ioordeveloped by HealthCare Se-
curity USA. ThIs includes a synopsis of the various
guidelines discussed In each section. The tool i. de-
signed to doaiment a s e l f _ of the health care
facIDty and the SIeps taken to develop or strengthen a
WOrkplace violence prevention program. The following
steps are suggested for optimal use of this tool:
individuals Involved In the .-ment process
should familiarize themselves with OSHA 3148.
PeJSOns conducting the assessment should check
whether the institution is In compliance by checking
yes or no.
 105

- 7 -

The next box aDows (or amunenIs and docamenIa-

don including actions, penons reoponoIbJe and time
tables. The ftnaJ _ shouIcl be...eel eo docu_
the monIlDrins and evaluation of eclI guideline In-
cludllI8 methods and dales.

Upon annpIetIon of this seIf..........-t analyIis

tool, fedJllies wUl haw abo established U\ oulline
which an be used to dewIop.1IOUftd wookpIaa!
violence prevention program bued upon the OSHA
guidelines.

Frodridc Roll g " cmifW prohlctiDn ",...",., t:ertifW

/willi Oft prottion llllministtrmw.,., t:ertifW ".,1It
CtITt riM _,.,.. """ ,."." ..,." . " . in NCMrily
~. He is",.,.,.., praiIImI of lite lntmwtitllwl
~for 1UIIlthDJn 5ta<rity"" SIIfrly.
 106

- 8 -

GUIDIIUNIIS POR PRBVBNTING WOItlCPlACB VlOUINCB JIOR HllAl.'DI CAIlB AND SOOAl.
SDVlCB WOJUCllRS: OSHA 31. .1996

CONTENTS 1NTR0DUcnON
Ifttrod1lction For many years, health care and oodaI service workers
OSHA's Comndtment have faced a significant risk of job-related violence.
Extent of Problem Assaults repreaent a serious safety artd health hazard
RisIt Factors for IIIeIe Industries, and violence against their employ-
Overview 01 Guidelines ees conIinuea 10 Increase.
Violence Plnendon Prop_ l!Iemenia
Manegernent Commitment and Employee OSHA', new violence prevention guidelines provide
Involvement the agency. recommendations for reducing workplace
Written Program violence developed following a carefu\ review of work-
Wcm..lte AnalysIa place violence etudIa, public and private violence pre-
Records AnalysIs and TracIdng vention programs, artd consuIlations with artd input
Monitoring Trends and Analyzing Inddents from stakeholders.
ScreenIng Surveys
Workplace SecurIty AnalysIs OSHA encourages employers 10 nGbIbh violence pre-
H.tzanI Plnendon mel Control vention programs artd to track their progreIS in reduc-
EngIneering Controls and Workplace Adaptation Ing work-related assaults. Although not every Indclent
Administradve and Work Practice Controls can be prevented, many can, artd the leverity of inju-
Post-Incident Response ries sustained by employees reduced. Adopting practi-
Tralnlns Uld Education cal meuures such as those outlined here can llignlfl-
AU Employees cantly reduce this serious threat to worIcer safety.
Supervisors, Managers, and SecurIty PenonneI
Recordkeepina mel Enluallon of the Prosnm OSHA'S COMMlTMENT
Recordkeeplng The publication artd distribution of these guidelines Is
Evaluation OSHA's first step In assisting health care and oodaI
Source. of Aut-_ service employers and providers In preventing work-
Conclusion place violence. OSHA plans to ronduct a coordinated
Refennce. effort ronsisdng of research, Information, training, ro-
Appmdides operative programs, and appropriate enforcement to
Appendix A: SHARP Staff Assault StucIy (Staff accomplish this goal.
Survey)
Appendix B: Workplace Violence ClecIdiIt The guidelines are not a new Slandard or regulation.
Appendix C: Assaulted artd/or Battered Employee They are advloory in nature, informational In rontent,
Policy artd intended for use by employers in providing. safe
Appendix 0: Vlo\ence Incident Report Forms and healthfu1 workplace through effective vlo\ence
Appendix E: Other Sources of OSHA AssIstance prevention programs, adapte4 to the needs and re-
(Publications, Office Dtredoty, Programs sources of each place of employment.
a.Semces)
Appendix F: Susgested Readtnp l!XTI!NT 01' PROBl.EM
n- appendides can be obtained throush OSHA at Today, more assaults occur In the health care and s0-
Its Web slte-_.....""'/~. Or roD- cial services industries thUlln any other. For example,
tact OSHA directly at (202) 21~1 or OSHA, US. Bureau of Labor Statistics (SIS) data for 1993 showed
Department of Labor, 200 Conatitutlon Drive, NW, health care and oodaI service workers having the high-
Washington, DC 20210. est incidence of assault injuries (BIS, 1993). Almolt
two-thirds of the nonfatal assaults ocx:urred In nursing
homes. hospitals, and establishments providing res!-
 107
- 9 -
dentia1 care and other sodaI oervIa!s (T0IClIIl0 and
Weber,1995).
A.....ults against worlcersin the health professions are
not new. Aamdlng 10 one stuc!y (Goodman et aI., 1994),
between 1980 and 1990,106 occupational violence-
relalled d""ths oa:uned among the following health
care workers: 'Z1 pharmacists, 26 phystdans, 18 regis-
tered n ........, 17 nunes' aides. and 18 haJth cue work-
ers in other occupational categories. Using the National
Traumatic Occupational Fatality databue, the study re-
ported that between 1983 and 1989, there were 69 reg-
istered nurses killed at work. HomIcide was the lead-
ing cause of traumatic 0ttUpII1ionaJ death among em-
ployees In nursing homes and personal caJe faci1itles.
A 1989 report (Carmel and Hunter) found that the
nursing staff at a psychiatric hospital suslained 16_
saults per 100 employees per Y""f. ThIs raile, whidlln-
dudes any uault-relalled injuries, mmpues with 8.3
injuries of all types per 100 full-time workers in aU In-
dustries and 14.2 per 100 fuD-time workers In the con-
sInlction Industry (BLS, 1991). Of 121 psyddatric ho&-
pital worken ...stalnlng 134 injuries, 43 ~t in-
volved lost time from work with 13 percent of those
injured missing more than 21 days from work.
Of greater concern Is the llI<ely underreportlng of vlo-
lence and a persistent perception within the health
care industry that assaults are part of the job. Under-
reporting may reflect a lack of institutional reporting
polities, employee beliefs that reporting wiD not ben-
efit them, or employee fears that employers may deem
assaults the result of employee negligence or poor job
performance.
RISK FACTORS
Health care and soda! servic:e workers fact! an in-
creased risk of work-relalled assaults stemming from
several faclors, including:
The prevalence of handguns and other weapons as
high as 2S percentS among patients, their families,
or friends. The increasing use of hospitals by police
and the criminal justice systems for criminal holds
and the care of acutely distuJbed, violent individuals.
The increasing number of arute and chronic:aJly
mentally ill patients now being released from hospi-
tala withoUt foDowup care. who _ haw the rtsht
10 refuse medicine and who can no lonpr be hoepi-
taJIzed Invohmtarlly unless they poee &II immediate
threat 10 themselves or others.
The avUlabillty of drugs or money at hospitals,
clinics, and phannades, making them HIr.eJy robbery
targets.
SituatiOnal and cin:umstantlal facton such as unre-
strlded moftrnent of the public In dlnlcs and ho&-
pitaJs; the In<reasing presena!! 01 gang members, drug
or almhol abusers, trauma patients,.or dlltraught
famlJy members; long waits In emergenc:y or dinic
are as, leading 10 client frustration over an inability
10 obtain needed ~ promptly.
Low staffing JeveIs d..tng times 01 opecIfk In<reued
activity sudl as..-I times, visiting times, and
when staff are transporting patients. .
Isolalled work with clients during examinations or
treatment.
Solo work, often In remote locations, partIc:uIarIy In
high-airne settings. with no back-up or means 01
obtaining assistana! such as communlcation devIa!s
or aJarm systems.
. Lad< of training of staff in recognizing and managing
escalating hostIJe and assaultiYe behavior.
Poorly Iighlled parldng areas.
OVERVIEW OF GUlDI!LINIIS
In January 1989, OSHA published voluntary, generic
safety and health program management guidelines for
aU employers 10 use as a foundation for their safety
and health programs, whicl\ can Indude workplace
violence preYention program.6 OSHA's violence pre-
vention guidelines build on the 1989 generk: guidelines
by identifying mmmon risk fadors and deIcribIng some
feasible solutions. Although not exhaustive, the new
workplare violence guidelines Include policy rec0m-
mendations and practical mrrective methods 10 help
prevent and mitigate the effects of workplace violence.
The goa1ls 10 eliminate or reduce worker exposure 10
conditions that lead 10 death or injury from violence
 lOS

- 10-
byla.......... _ - - , . _ _ _
..." ......... """"""' ....... oe- _ _ . . . _aD --.-, ouporvtoorw._....po,..
.... """'P---....--JIIUIP""'IO ....

",...--",_.-...-",-
_
'" autbority _ _ 10 aD.--
thdrobllptlono. AppropIUeIlllocodoft
portia

nIty--..
oodal_
who pnmde_... _ .... IftpoydU-
atrIcfadlltllt,hooplal_cIepo--. _ _
cIInIct,druI--dINcs.
A IY*'" "'_Uty for Involwcl--.-,
oupentooro. _.....,..,...
~-nty ... - . . . - . . . . . -
.... ~ ThoflndadeJlhylldooll.. ........
-~,,-pnctI-.~
__- aIdoo,lhonpoIo.--"pabIIc

---.....,,---
....... "u_ _ _ ....
..... -.-.......,,-..._penomoI.
-.aodaI/wo
_

-----
_ , .... .-_ybe.-utn~rIIb c:oo..n_to"'l'P'Jll .... ~~
for _lIuy ponomeI-'> .. " ' " " ' - cIIetory,
dorIcaI.
.... ....
aodaI _ _ty_~tn
_ .... _ ... """

VIOLINCI! raBVIIN110N PaOCLUll!LlNllNTS

~ ...
to cIewIap _ _ _ _ own_1O
1IIIoIy _ _ .... pnmdeUllfal_to
n- an four ...................... 10 any_ ootety ....... 1mpkmmt._enJua...... ...........
.... _ ... JIIUIP"'" _ .... apply 10 JIft'W!I'IIns
worIIpIace _ _,(1) .............
.....,... tn90lwment IhouI4 lndade .... foIJowtD8:
~_

...,.,..",.. .." , , - (2) _ ......., . , (3) ......

ani JIftV8ltlon _ 001\lI01, _ (4) ootety _ _...
U~_~w\....... workpIMe
~
...,_....-_ proanm_oe-oofety_
-ty-
MANAGIINIINT CONMI'IMIINr
AND IIMI'LOYIIlINVOLVDIIINT
_............... __IIaI_"'...
............'commI_ _ empIoyeetn_

_or_
tIfe:-
"woofety _ _.............. T o _ ... - ' "
popom............-----....,."...-
work 1OpIhor, portwpo tNouah.
1'nImpt .... -~"'--1I.
PartIdpotion on Nfety _ _ _ _ or

'w-ch-II empIoyonopt for lido

be COftfuIIO """",y _
_.'!hoy . . .
.... appIIcoI>Ie ~ '"
_ ...., ......., roporto"'vtoIentlncldentoor
oecurIty~-fodUty~
.....,..s- _ _ Iorallld..
.... NatIoNi..-_Ad.
..........
~"""-"'IncIudIns""-
.... __
_ " . _ _ _ IO _ _
In"'I_t"'lOp~tpnwlclos
y_ T...... porttn""'tInabIs_proanm ....t
....... 1IdWqueo to...,..u.o 0I<0IatIns aptatIon,
workpIace.-. _1hOUI4 tndade .... foIIowb1s: - ... _ _,or-....InIent_~
.JlPIOFIIaIe reopGI*O.

EquaI _ _ IO_ootety _ _ _

potllfttl_ ootety.

AIaIpod....,.,...a.wty lor .... - - ' " ' "

WUTI1IN
A_

....--
PaOGaAM
propam for job oofety _

.... .......-.-._....."....
_

-
ty, _ _

JIIUFOIft, offen ... effectIve.wr-h for ...... orp-

_ _ In.....u..---. .... _ -
- b e _ o r .....,,~tobe..-.
 109

- 11 -

tory. What to needed are - . pis _ objectI_1o WORJCSITE ANALYSIS

_ t workpIoae.tolenae suitable for the ......... WcnbI.. ONIysI. blvaI.... soep-by-tIep, _ _
oompIoxIty of the _pIoce openo_ ..... odoptabIe _Iook.t die workpIo<e to And elIIstIng or .........
lo~oItuo_ln _ _ _t. tialhozudslor wmIcpIooe vIoIen<e. ThI . . . -. .
viewI"8spodflc~_oropeno_thet_
Thepftftft_popom _ _pda.. _be u"10 hozuds_spodtlc _ _ hozudsINY
_ l e d 10 on employees. At. minimum, develop.
..........,. vIoIen<e ptewn_ prosnmo _ do
the follOwing: A '"I1vat"-T......- ~_u\tT......
oImIlor _ fonle, or monIlnolor may._ the vuJ..
c.... _ _... cIeorpollcyof_ ......blUIy 10 workpIo<e YIoIonce _ d _... the ....
1o_1or wmIcp.... vIoI........ _ _ ......
__..,_ ....Ied_-.,.,_ proprio" preventi... octIons 10 be token. ~
blS the workpIo<e YIoIencz prevention popom then
_ co-wodcen, _ _ poIIenII, _ vIoI_
maybe uoIgned 10 IhIo group. The"'m _ lit-
_ be od_ of IhIopolicy. dude....-.lati_from_~ ........
tioN,empIoyee _ _,_Iy, _ _
E_thetllO reptt....... _ opInot Oft osIety ..... -1h.1epI, _ humon...,......._.
~whoroportoflt _ _ _ wooItpIoce

vioIInoe. The ...... fit CX>OCdInoIor <01\ review Injury _ m_

record. _ _ ~daIrnolo-tIfy

I!ncourIge ~ 10 promptly report Inciden.. poltlemo of _u1athet rould be prevented by work-

_10 ...... wayolo _ or ellmIno.. risks. pIoce adaptation. pro<!!dunl chonaa, fit........"..
Requi",reconI. 011_.. '" _ _ ..... to trainI"8. As the ...... or monIlno.... _ oppoo-
plio" amIrols. _ _ be Iftstituled.
"""''''propeo&
0UdIne. "",~ve pion for moiIItoinIng_
rily bI the wooItp...., which Indudeo
IIoIoon wllh Io..
_
_t~lati

who CUI help identify woyo 10

mltip.. workpIo<e YIo!once.
_t_
_blilhiftg.
__
the _ _ _ popomlor_.. onoIyIiollt-
dudeo, but to not Umlled 10, ONIyziftg _ tncIdIIg
records, monIloriftg _ _ ONIyziftg_ts.
ICfteftIng suroeys, _ ONIyz1ng _pIoce - I y.

JlECORDS ANALYSIS AND TRACIaNG

AoIIp reoponsIbIIIly _ .uthority lor the program _~
This _
Odivlly IIhouId Indude _
-" 8Jecmdslndud-
medical. ookty,
'" indIvIdUllis or ....... with 1f'I'"'I"Io.. 1roiftng
_ oIdIls. The written pion IIhouId ......... thet then! inS the OSHA 200 iog,lf roqulrm 10 pinpolnt_
..., odequo.. ...,........voIIoble lor IhIo effort_ of wooItp.... vIoIenoe. Scon unit lOSS - 0IJIPI01ee
thet dIe ...... or ..,..,....-lIIdIviduslo cIewIop _poIIceroportoollnddenlOor_oI
~Oft worIq>Iooe _ _ _ In_1h uooulti... behavior 10 identify _ anolyze _ bI
core _ socIaI_
uaoula ....ti... 10 porticuIor departmen.., units. Job
titles, unit Odivltles, wort. slatlons, _lor time 01
AIIImIINIJIOgOIIIOftt commiImonl 10. worker- day. T.buIote these dala 10 target the frequency_
supportive envl""""""t thet places u much impor- _ I y of Indclento 10 establloh. _Ior __
tance Oft employee osIety _ _Ih u Oft oervIng
inSimpro........t.
the potlent fit client.
MIIIIilo!I"8Trenda -AnoJyobla-
Set up. c:ompsny - " 8 u put of the Initial effort
"'----.......,mrcosfety, ...pport-
CoIIIacting oImilor IocoIbuoI_
_c:oawnunIly_dvlc _to_way"'
trode-.
......
I n g ' - empI~, _
fodIllati"8 '"""""'Y. .boutlhelr _ _ _ wilh __

==
~

help identify trends. Use"""" yean 01 dats.1f p0s-

SIble, 10 nO! trends of Injuries _Incldento of-.ol
oretial YIo!once.
 110
- 12 -
Saoes>Jna s_
One Importont ocnenIns I00I10 to stft ~ a
~or_topt_ldeas..,the..-.
tlallor violent lncIdenll and to identify or conIIrm the
_ne
_lor bnprowd oecurity_.....
DetaIled
dUdeclat _
ocnenIns surveys can help pinpoint
tub that put employee at risk. Periodic surveys c:oa-
annually or whenever operationa
change ... irIddents of workplace vlolelu ocxur help
identify new or prevtouIIy unnotk:ecI risk _ and
deftdendes or laBu.... ln work prac:tI_ proc:edu....,
or control.. Also, the IUrveyt help ..... the effects of
c:hangw In the work procesoeo. The periodic review
~ should also Include feeclbad< and 1oIIowup.
Independent relewers, such ... oaIety and Malth pro-
fessionals, law enforcement or security opedolillls, In-
surance oaIety audllll<S, and other quaBfIecI penons
may offeT advice to .trengthen programs. These ex-
perts also can provide _ pmpodI_ to bnprooe a
violence preoentlon prosram.
WORXPl.ACB SECtJRITY ANALYSIS
The 100m or coordinator shouJd perIodlc:aDy Inspect
the workplace and .muale empJoyoo tub to identify
huards, rondltiona, operatlona, and "lIIationa that
could lad to vtolelu.
To find areas "",ulring IurtIu!r evaluation, the 100m or
coordinator should do the foUowing:
Analyze inddents, Incloding the _ of
_ I I and _ an aooount 01 what happened
boIoro and during the inddent, and t h e _ t
dotaUs of the "illation and III outcome. When poe-
sible, obtain pollee reports and recommendations.
identify jobs or Ioc:atlons with the _ .... risk 01
violence as well .. procesoeo and procedures that
pot employees at risk oI ....uJt Indudmg how oIIen
and when. Note high-risk factors such as types 01
clients or patients (e.g_, psychiatric conditions or
patients dl..riented by drugs, akohoI. or .tress);
phyoiall risk factors 01 the building; IooIated Joao-
tIons/job activities; IIpting problems; lad< 01 phones
and other oornmunkatlon devices, ..... 01 easy,
unsecured access; and ...... with previous security
problems.
01996_SodoIyC __
OooNodll_CIIkoso, _ s.p-tngotIM_.Hooplal_
Bvoluate the effec:tI....... 01 exllllna oecurity .....
_lndudlna~naCOftbol_
DotonnIne 11 _ _ ha"" been reduced ...
elbnlnated, and take appoprlate ac:tIon.
systematk:
_ _ through
_II!_t
HAZARD PREVENTION AND CONTROL
After hazard. 01 violence are Identified through the
work proctk:es to
analysis, the next step 10 to deoIsn
ensu-tns or adrrinlalnodw and
or c:onbol these hazards. II
vIolelu does oc:cur, posI-inddenee resp<>IWO can be an
bnportont tool In preventing future incidents.
BNGINI!BRING CONTROLD AND
WORXPl.ACBADAnATlON
naineerins ron!rOb, lor example, remove the hazard
. from the workplace or ......te. barrier between the
worker and the hazard. There.re oevenl_
that can effec:tIvely prevent or control workplac:e haz-
ards, ouch as thoR actions presented In the following
paragrophs. The oeIedIon 01 any .....sure, 01 course,
should be hued upon tho huards ldentlfleclln the
worI<pIac:e security analysis of ...,h fadIIty.
A.... any plana for new construction or physical
changw 10 the lodItty or workplace to eliminate or
reduce security hazards.
InstIIII and regularly maintain alarm s y _ and
other security devices, panic buttono, hand-held
aJarms or noise devices, c:eIIuJar phones. and private
chInneI radios where risk is apparent or may be
antldpated, and arranae
for reltoble response
or- when an alarm t. trtsBer<d.
""'vide metai d_rs Installed Or hand-held,
where appropriate to identify guns, knlY1!S, or other
_pons, according to the remounendalions of
security ronauItants.
Use a dosed-drcuit video recording for Ngh-rlsk
areas on a 24-hour basis. Publk safety is. greater
concern than privacy in these situations.
Place CUJ"Ved mirrors at hallway tnbenections or
concealed area.
Enclose nurses' StitioN, and install deep service
counters or bulletresistant, shatter.proof glass in
_
 111

_ _ _ _ poIIoe_ ...Io _ _

ton. Report" _ olvlolonae.

Provide police willi phyokaJ Ioyouto olladlJlIoa to

expedite Inveotiptlona.

Bllablllh "time-out" or oedUIioft .... willi hlp Requi... employeea to report all_to or_to
.c:eIIingo without grids lor ",,_to ~ out oN! to a supemaar or ma.....- <e.g., con be amIIdential
___ -Ior-""

B
to. interview). KMp Iog _ _ rwpono ol ouch _

moxImIzeaJm!ortond
ProYido _torpatlont_ _ -.._dooIpod '" dento to help In cletermlnillsony - . y . . -
to.......,mfwther--.

Advile ond _~ U - . ol CXIIIIpOfty

_ _ _ a,.orpotlllllCOlW _
two""'...
""""
~""~poIIoe-
charpo _ _ulted. ........
LiINt_"'''~_'''''
_ _trolled by ..... _ - . . __
In_ _ or _ _ _ _ _
ArnDp~",pe.--""",oloaff.", Sot up a trained _ _ team to reopond '"

_ be mInImoI.lltlhtwolJht. wlthout-.p .....

..........-
U""~tnlnodleCWity-' __
..... or ...... ond/ar _ ' " die floor. Umlt die
_ _ beaoedu _
n_olplctwa. _
_""IIa1f,ar_- II1II)', to deal willi aar-ve behavior.

--
Follow written IeCWity proced_
ProYIdoIocbble ..... .,....,botlvoomofor_
_ _ _ fnlm""-..:JIont.ond vllilor
Ensu... adequate_ ~ tniNd otaHfor
rostraInInc ",,_to or_to.
_
LocItollunuoeddoon",_t...,...,ln_
_ lin! ........ ProYldo_w _ _y information "' _

-
waitInS In"" or In -tins _ Adopt_
10 ' * ' - -tins time.
_~_ ........ _ o n d _

....... ~~-- .....

_ adequate ond quaJIfted oaff<o. . . . atoll
_ _ 1lDwol _ _ rIoItOCtVduda&",,_
lIanIIen,emorgtIIC)' _ _ _,aadot
nl&hL LcaIes willi the _ _ rIoIt inducIeacIJD.
......._ . Always lock a..-.....
KMp .............. Uaoed In tht~ woII-
_ uDlto ond Q\aII ar acute care .....to. .Other rtab

ADMlNIS11IATIVII AND
Indude admIIoIon 01
Iont behavior or _
""tI.....
activity.
willi a hloay ol Yio-

WODC PllACDCE CONTllOLS

viII_
..."joboor _ _ ~1le-""'-'-

_t
Admlnlabatl",,_ worItpracticacomroltalfoctthe

n~lehowchanpo In W<IIk.....-ond~
llatl"" proceduna con IIIIIp ~tnddento.

Stale cIeorIy to ",,_, cilento, ond ....pay.. lllat

InItitute alllp-ln """"""'" wllII..- for
eopedolly In a newborn nunay or podlatrlc cI..,.n-
menL Enforce villtor houn _ procecIurft.

Bstablllh allot oI"raIrIcted villton" for " , , -

with a h1-.y ol vIoIonae. CdpIeo _ be a _
violence Is not permitted or _loll. able at IeCWitycheckpotnto, _ ...tIona, aad

"'-=== ..
----.0000e0.-- ;;:c........x_n:::;:I_
 112

14

. . .ID_. .
_Iip-Ift _ _ ad _ v i i i _
choc:k.,-.--r. Llril_
........-_ol-.
~_~- -rmsjowo1rylDhoIp

----line
SapervI.. die movanonl of poydIIatric _toad prevent pcooIble IIroJ1SUIotion In amfrontotlonol
pollento throupoul die focIIIty. 01Il10_ CommunIty war..... ohouIcI cony only
""'-Idonlillcotimandmoney.
Control..,.,.. 10
-portIaIIodydruc-. .. ..........",- I'eIIodIc:aIIy _ die fIIdIIty 10 ........ _ or
~1eftb)'vIIIlDrlor_1IIff
pncy __ .. _-In
ProNbIt~_ .............. I n _
c:IIniCI, portIcuIady at ntpt
.. _ _ Io_..uobIe. 1!mpIoyes
whkII_ be _lbapjiioplallly b)' po_

. ~1IIff wllh ldon_tIon bodpo. JI"IfoIOIbIy

IhouJd_ ...... _ ............... _1oot_1D.....wy nrIIy IIIIpIoyaw

_ _ paIIcIeo ad pro<>odun!I ""'-"""'"-

and _ _ _ tIoN.adfar_~
. _ _ _ _ be_
a-np""'floyfto .. _keys
-corrytos _.........
Np-rIIk.,.-atntpt(.... _ _ Iocbd
~. r.o.tdeltlff_wllh-..My_1D
A-mlndle_vtonI~ol ..... _ _ ~_In""""""""''''''''
_ be JUahIy YIIIbIo, ad IOfeIy
_~
_
forraI po_1D 1eom - l I l Y put _ .. _lelDdIe~.
. .....l I f t _....... _.~_ ..
_ ...... _ ........ _nportolD .'
IdonIIfypo_ad _ _ ..wllft _ _ . u. die "bucIdy.,-.. tOpOCIaIly _ ~

IOfeIy moy belllnotoMd.lncounp home heoIth

"-""1ooepIng In mind patient ...........lIoIIty ' '''''provIden. _ _ ......... lNIoIhento
....s ....... -,._Updo.... . -. .WIId ~oItvo_ SIoftIhould_
_ ................. . . . - - . a n d _
n.and/.. _ _ ......... . . . - _ ~_y .... _ _ "_Io.
tonlotlwly _ _ _ otII_priwI<y
....s_ty(............. _ _ -~ .....-poIIco_lI-
portIIIonII. DnoIop poIc:IIIad ~...-tns-
. u..-~ _ _ _ __ 1IooIIh ... pnmdoro, _ .. _tnc:to 01\ how ...
111_ beCDNlac:lod, d I e _ ol oIhenln die
ad oupenIoon to cIIooa _,. 10 effocIIwIJo _
......-,-..- home d1IrIns die viii... ond die _ t o pnmde
_ I n .deuIy ......... 1ItvotIon.

-...,."..-
I'Iopre CXJIIIInSIDcY pIoN 10 _ _ who ...

. . . __
dooIpollOd
BoIobIIoII. dolly worIt pion_
CIlIIIoct....- iliff to
forlleld_ I _keep.
0diIIS0Ilt" or 1IIOIdna ..... o r p h , - t -..
-~
~(CIIAI'I)
........ ~ _ _ or
_ lhrvapoutdle-.t8y. U ........
"""" _ _ npartIn. d I e _ . . . . - _
ocaapallollol heoIth _ i l i f f to hoIp ell"".. po- foIIowup
.....1 0 . _ .......

--.
. ca.tact .......-..... J'OII"IndcIont~
_11111... orc:IkIltI
1'JuwIer ...uIIlft _ tID "1It'IdI!
_ _ c:we..........
-....
~~u_

far ""'fIoyfto who ...... _ oabJocIIOd t o _

....... _ _ _ ondIor,..,.... _ _

i.====Lra:a:::==Jz:.....ic;:t~
Ooo_-'~_
 113
- 15 -
POST.JNCIDENT RllSPONSE
Poot-Incident _ uu1evoluation are _tIaI to
an effective violence pre_lion prognun. AU work-
place violence prognms should provide aHRpre/Ien-
sive trUtment for victimized employee uuI employ-
ees who may be traumatized by wltnesoing. workplace
vIoIen<:o InddenL InJ'nd _ should _ve prompt
trU......,t and psychologjaolevoluation _
..ult takes pIa<le, ~oIseverity. TraNpOrtation
an ...
of tile Injured to medical care should be provided U
care t. not available oHte.
Victims 01 workplace violence ouffer variety of con-
JeqUOIIC<!S in addition to their actual physicallnjurt...
Theoe Include short and ~ poychoIogk:aI
trauma. fear of retumir>S 10 work, changeo in relation-
&hlpo with ...- . . . and family, feelJnp oIlncompo-
tonce. guDt. po _ _ _ and feat 01 crltldlm by ..-
pervtoi>nor ........... ConooqueNIy, a - . . . foIIowup
program for _""'*'- wID _only hoIp them 10
dell with _ problems but .... to help ~ them
10 conhont or prevent future Inc:Idents of vIolenca
(Flannery, 1991, 1993; 1995).
n- are ......1types oIualstsnce that can be lncor-
porated inlO the poet-inddellt responae. For example,
trauma-<:rists counaellng. crltlallnddent atresa de-
brIeIIng. or employee _ _ prosrama may be pr0-
vided to uaist vIctIrna. CertIfIed employee _ _
~, psychologists. poychiatrbts, ctink:aI
nune spedaII.... or aodaI worken couJd provide this
oounaeIIng. or the empJorer can mer stoH_1O
an outside spedaliJt.ln additiorL an employee <OU1\-
aeling -.rice, peer counaeUlljJ. or support groupo may
be_
In any c:aae. counaeIon mUll be weD trained and have
good understanding 01 tile I_and ~
of _ults and _ ......... violent behavior. Ap-
propriate and promptly rendered poet~nddent
debrieftngs uuI counaeIlng reduce acute paydwlogIcaI
trauma and general_levels among vlctIma and
w i _ I n addition, such ~Ilngeduca"'_
about workplace vIo.1ence and poet~veIy Influences
workplace uuI organiz.otlonal cultunl norms to re-
duce trauma _ t e d with future Incidents.
TRAINING AND BDUCAnON
Tnining and education eNure that all staIf are aware
01 potential security hazards uuI how 10 pro4IOct them-
selves on<! their co-workeB through eatsbUahed polI-
cies uuI procedures.
All Employees
that_
Every employee should understand the concept 01
"Uni....... PrecautioN for Violence: I.e.
should be expected but con be avoided or mltipted
throush pepontlon. Staff ohouJd be _ 1 0 limit
physical in",""",1ioN in worltplaoe a1ten:atlono..-
ever poIIiI>Ie, W>Ieoa there are adequate nunUn 01_
or emerget1Cy _ ....... uu1-=ur1ty _ _
available. Prequont training 0100 can Impn>ve the likelI-
hood 01 avoiding _ult (Carmel uuI H _, 19901.
Employees who may lace aafety and security_
should receive fonnal instruction on the specific: hu-
ards _ t e d with the unit or Job uuI fodIIty. 1bIo
induda Information on tile types 0I1njurieo or pr0b-
lems identified In the fadIlty uu1the methods 10 con-
trolthe specific hazard..
The training program should Involve aU ~
including aupervIaon and mona.... New and...-
signed employees should . -... 11ft initial orientation
prior to being uaIgned their job duties.
Vlliting _ , such as phylidana, should '-vethe
...... tnIning .. ~tstoH. QuaWIed_
should Instruct at tile comprehenlion IewI appropriate
for the stoH. _ ... troinbIg propuno ahouId In-
volve role playlng.limulatioN, and clrliio.
Topics may Include Manogement 01 Alaulti... _v-
lor; Pro-... Alaull Reoponae TnInIng; poIIce_
Nult avoidance prosrama, or.,.-..I aafety tnInms
such as awateneSl, avoidance, and how to prevent . .
saults. A combination of tnIning may be used depend-
Ing on the severity 01 the rIaIt.
Required tnIning should be provided 10.....,..,..
annually. In Wge lnatitutiona, _ progromo may
be needed more frequentiy (monthly or quarterly) 10
effectively...ct\ and inform all employees.

- 16-
The woottpIo<Ie.-.--tIon policy.
_y~tIonof"'''lb1gbehavlor.,.nIt'CJIP'l
tIon of wamIng!llp or situatlono tNl moy _ 10
_ula.
Wa)'O of.--tIng or dlffurlns ..,..dle lituatloN
.. _ _""bohavlor.""""'8in8 ....... _ appro-
prialOlyur/nsmedicallonau-'_a.
Wonnatlon
_tMlyto 01\
_ _ _dlvetIty
mult1cu1two1 _I r
toI d_
dewlap
A 1IandonI _ _ plan lor violent situa-
tIoN. indudlng a.....bllity 0 1 ' - " : " _
10 alum . , - . _ communication J'I'I'ClI!CIuft
How to_willi _ penoN _than pII-
lien.. _ c:Uen... 1IIICh u relatl_ and visilOn.
.......... ve behavior amtrol methods _ _
_ of_lappikation oreo<ape.
The location and operMIon of oaIety devlceollUCh u
aIann.,-. oJong with the requirai _ _
_ules _ proced.weo.
Wayo 10 p1U_~ _ coworbn.1ndud1ng
_ 01 the "buddy .,....,.'"
Po _ _ proced.u_1or roporlillg_
rea>nlkeepiI1s.
PoUdeo _ proced._1or ~ modica\CAft.
counooIlng. _ "",..,..~orlepl_
_ .... a vio1ent epioode or injury.
s.pem.on.-",,_Secarltyr_
SupervIaon and _1IIou1d _ _ tNl ....ploy-
....... notploced in ....gnmen.. tNlcompromile
dento.l!mpIoywo_ aupervioon _Id
ufety and ohouId encourage emp\oyeeo 10 reporIlnd-
be Irainod to
bohavecompuolcmalOly t o _ coworbn when an
Il1ddent occun.
Theyohould learn how to _ _ Iy _ _
........, tNl ....
._-s::;. _. . . . . . . _.HoopiIal_
pIoyees.-"" appropriate trainl"8.
o. _ _ a.tcoao..... .....
114
~"""" ...
~ _ _ _ be
_ toJOClD8llbiea potI!nIiaIIy _ _ and
.. _any-r~In""pbyrlmlpIont.
tIen,COft ....
_ _' _ _ 1Iafft.,.poIIcy_
proced...... to led_or eliminate .... _
Securily penonntI_ opedflc: training from .........
pial or cUnic. including .... poydIological componen..
of handUng",-"" _ .......""d....... oypeaol
dloordoro. and wa)'O to hancIIe agreooion _ _
hoatIIe rltuatlona.
The traiNng program _Id . . . lndude &II evalua-
tion. The COft.....~ methods. _ frequency oItraiNng
"-Id be _ _ _ evaluated annually by ....
........ coordinator responrIbIo lor implementation.
Propam evaluation may Inwln ..........- _lor
employee In..mew.. -.g and oboervIng. _ I..
reviewing roports of behavior 01 Individuals I n _..
ening situations.
KECOaDJC1!EPINC AND EVALUATION
OP THE noCItAM
_keeping and evaluation of the violena! ptnen-
tIon program are necesaary to cIec.rmIne 0 _ _ _
tI_ _ identify any _ or c:han&s tNl
ahouId be made.
"""""'Ing
RecoodkeepIngIs-*lto .... _ 01. worI<J>I-
_.---propm.Goodrea>n
ahelp .....
pIoyondetEnNne .... .....-Ily 01 .... pn>IJIem."-"
_ 01 huon! aJIIIrOI. _ identify 1niNng'-"
Rea:>I'dI can be espedaIy _ to ..... orgonIzaliona
_Iornw:mbenol'_pouporlrade_
lion who "poo1" data. Rea:>I'dIof \njuri<o. m-. __
dentI,_.haauda,_~pe __
riel, _ tn1ning. among others. can help identify po\>-
lema and ooIutiono lor an effoctIve program.
The following record. are important
OSHA Log of Injury and Din... (OSHA 2(0). OSHA
resutallons roquft entry on .... InJury _ DIneoo
Log of any Injury tNl requlJe """" than flnl ald.
Is loot-time Injury. requI.... modified duly. or
co_ lou 01 CONdou_9.1This applieo only to
establishments requ1recl1O bop OSHA Iop.) In,...
ries ca~ by _ults. which .... otherwise rea>nI-
 115

17

able, aIIo _be

ao-..p.e __ ..._ Intile
01\ tile..,.
hoopI_ A /atollty
_ oI..

....... morehoun.
wllhlnelgh. employfto JIWIt be '"""""" .. OSHA
lhIo _ _ _ .-....
from worIcpIac:e YIoIenc:e end
Uohments.
oppII_" aD_ Eltabl....... 1IJIIIonn 010_....,.,..... ~
end ,.war _ of reports.
""",","Ior _01_
MedICIII reports InJuryult_belrept.
work_ end....,..,.uor.'
RmewIIIg NpOrIIend min..... from _ - . . . .
n- reamIa _
..... ~-.-
.............
deoaIbetlle type of _UJt,
.. p o - . " . -
who _ _u1tocI;endaDodw_
_oftllelllddollL

TherecordllhoWdlndude. ~oItile
_ro_
oaoofetyendoecarity_

AaoJyzbos tJendI end ..... 1ft m-/bojIJIy ..

fotolltlet muted by vtoIeate _ .... INtIoI ..

..,_or~ poIOIItIoI ...octuo1 .... M-.!rclJnpJ\>wtlllOl\tbued Oft - . . the

loot ti..... end tIIe ...1Ift of 1nJurIeo- fJequency end _ t y of workpIooo _ _

lncIdaaof.-. - . ....... or..,.-.e

behoYlor _ ....y be -1eftIns .. tIIe _ _
KeopInc""-"_oI_....s
work pro<Ikle choapo
lenceto_ .. _ to_ _ - workpIoce_
.-
lnB
butclo_ . ......",_
_ ........ .-_ .._ _
~ .. ohoon-
end of 1I
_ b e - . pedIopouputof ... _uJtIwt
IncIdent~ n-reportt_be_1od
""'-"by t h e _ deputmenL
worbIIo-.....
SurwtybIs""'I'k>Y-
..... oyaIIomoto _ -_end
_ oller ......... ,... ..
_
~oocurIty_ ..

Wonna_ Oft polenll willi. hI*'Y of put_
Jence.cbuJ ....., .. - - t y - be
_ on the potlolll'.dwt.AD_whoan
Ior.JIC*!NIoIIy..,-w._w. .. _ _
"'-Id be ....... of _bedqpound end-,..
KeepIns _ _ of ..... _ ............ lodool
willi vtoIeate 1ft tile _III core end oodoI _
fleldau_denIop.
SouwyIfti""'I'k>Y- who...- hootIIe __

---.
_ _ tthe _ _ _ they_wtdlal-
~of_dlenll_belogod ..
tIoIIy oad, opIn, _ _ oftInwanI. end_
help _

Mlmdoo 01
oofety..-... _01_
po4ionIIoIdIb.

..wy.o.end _ _ ....,.,ID... _end

...... . . - b e - - . . . s .
RecordIofaD ~"""""""""",end
qualllicaiiono of ......... _ be--'
CoiJIpIyInB willi OSHA end ..... ~II
Ior-..end ftPOI*'Idootllo,lnjoaIeo.-
m_
Req.-.poriodIc Iow _ _ oroulllde

E_oIIo"
Ao put of _ 0_ pn>p'OIII. cmpIoyerI_
""....... _oofetyend -...Ity _ _
c:onouJtont ",view of the wwkII .. 1or NIlOIIIIIIOIIII
_ on IInpnIns empIoyw II/ety.

. . . . . . . .--WOJkpIoce-
_ _ 1""11'"'" ........li0ii reports wi'" aD
Top .............. _ .....wtllepoosrom ..... em~Any-"'lnthe .......... " - b e
lorIy, end wi'" _h 1IIddoIIt, to _ .. JIIOInIIIIUO- _ . t ....... -...01 the oofoIy-.
cs.. ReopoNIbIe portia (~ _ _,end -....,.-..tI....... _employoell""'P'-
empIoyftIl"- CIOIIoctIveIy NOYOIuo.. poIIdeo end

.lW_s::;z:HIJIClO
Ooo _ _ ~ _ _
..........OIIC_ICPIOI_
 116

. . -pIooo---- -_....o.t.Io",_.,..,,---_-....
. 18

SOVIlCIIS Of ASSISTANCB c.oo..~_).;a-.._"oI.n ..~","-_"

.....,..,....who-.lclIlloo_In ..............
2CI{U:" ---,.......-.-~-
~
...... <Aft tum 10 the OSHA CoNuJtaIion _ _ .... c.n_ _

.
,
_
~
a
o
o
.
YIded In _ .Iote. PrimarlIy tupled a l _ c0m-
1JaIt,<>o_.....,.........
.,. .__. "----n
panies. the cxmsullotkm _ I s pnMcIed al no

_
charge 10 the employer and Is lNIependenl of osHA'.
enfottementoctlvlty.OSHA'.efforIslo_lempIoy
_Anml...................... _/"""' . .3OII7.

_-_
_ _I violence .... compIemeftIOd by
___'_
~

-.-..... w""""'"''''- -",,,,."SpodoIsw,"

ankmo,.......,,_
_ofNlOSH(1~and publlcoalety
oIIIdaIo, _ _ ......, ... " , -_ _ ott.
_.~cw.~.,

..,..,.,., and employee -.....,..."........ ..

....... other Intenoted poupo.l!rnpIo)'on and ..... ........---....... ......,_o..
.,.,J; ...... E.09lll)...,..~~!IIIarWIra . .
,.
-c-.o,---""",--"_-
pIoyeeo mayamtact these poll", lor additional ad _ _ ).n _ _ ", _ _ _
via! and InIormation.

CONCLUSION
OSHA rocognlzeI the importance of effectIft Nfety
and _
and _ _
J'IOtI'M' _ l i n provIdIna_
~ In fecl.0!IHA' ....--
_. . . . . .. ....,_............ ..--_n_
........ _

-.,-
.. _ _ s._CA.

_n _ _ ...........
-~,.....
....

~
I
lion _ _ _ help empIoyers_ and maintain T_Car. _ _ _ ( t t 0 5 ) . _ ..... _
_ and _ . wooIcpIaooo, and the oseq" Vol-
..... clLIINIr ....... W......... tc.TMle11 .
...buy PIotectIon ............ were opedfkoIly .......
and _ItIIreaJtI1IIze
UIhocIIo programo. worbl_
_ with exemplary
safety and _ Nfety
_ u.s.~tcl~n

' .... A_OO- ..... _

__ OWMI~ u.s.
..... No.NCI-'...... ~
pmo are known 10 Impn>ve _ monIe and produc- .... DC.
tivity and _ _ _ _ <Omf<IIA1ion CO!IL
u s . _ .. ..-,_ .. ..-_n_"-
.. -c....-.... ,.... _ - -
OSHA'._pevenIIon.,.-_"'_ _(Hft ~ ~ _ _ _ ..... . . . . . , _ . , ...
tIaI~Io~Nfetyand __ -',1_._ _.
pmo. OSHA __ thai the perfonnanc:e-Orled
__
appoach of the guIcIeUnoo provides employen with
_ t y In _efforts 10 nWntoIn _ and MaIthfuI
-.rondItions.

.,..... _ _ .. _ _ n_CAlJ
IlU1IIII1NCBS
_~A""'''''''''

_n_~_c.-

..s~Afdl""Pp.
. ."",,-,..-
'''''-'''~
..... .,."..., ........ "CIltJJOt.l9Pp.

_ _,);COdoe.c.;-r, ..... oI.nOlO).- . -...

OSHA..-",_--,._ ..""","","",
-,, _ _ s._CA. ~--,.-."""--,,-,,,.
........... n_ _ ..
c...o."'_,... n_ _ ....... _ ....... _ WNrAcllf"'CbIO,
~_~

_ ,.,c-.,......
. W_-..-.__IlopuWIohod........
400~ ..4

..... s.;_c.;_,I. ..... n,..,.,~I ..........C -

W_DC.

_~_L;_.....,.). nOOG." .._ ...........

...... A--. ..... c..w..-. ... u....t . . . ,
..... _/AMA2'12Q1~I-...

Ono _ _ ~ _ _
.1996_z::;c:ICC~J:c_=_
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rff II-,I 1Iff'i f

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iIi III1 t Itl IfloifJ! 1.1J i ~~ ::. ,
r I l,~lWIi r IIi- lIe.
I if I
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[ i(t lit t ![t tifl
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1ft
I~illt
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 HealthCare Security USA
"Guidelines for Preventing Workplace Violence for Health Cere
and Social Service Workers"
Self Assessment Analysis Tool

Facility Name Data(s) 01 Review

No.: _ _ _ ..",_tII ... _ _ .. OfIHA."...

[IJ_,.,,.,.--"'w_ _,.,_c:...__
_ _ -_ ..... _ .. - _____ "",.-_","_ot......,.. ___ o."",
_ _ _ ot_Socour1I1USA .. (IIJO--".
~T_
C iIIIIDoa.IIItIoo ........: =::a. . . . .,1nIDUIIng:
-'''- __
SEC'IlONI ....
I!l ....
____ ---8. . ,.1 ...
'-1 CoorfIIIo-1 00
...... ---~
-.,.--.-..
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135
 136

FOREWARD

This handbook is designed for the person ultimately responsible for the
security program in a healthcare facility. The format wm allow for overhead
projection of the various ,d mrts aDd graphs allowing for educational programs and
presentati.ons if desired. ,

The intent of tbis handbook is to define the role of security in the healthcare
environment by giving a briefbistorica1 prospective depicting the respon5lDilities and
authorities currently utilized. Various functions wm be addressed along with
staffing and equipment methodologies necessary to attain a viable security program.
Also covered will be how to develop a risk assessment process as well as a soUnd
quality management program.

Finally. tbis handbook will address the current trends and anticipate how
future developments will evolve including the interrelationships with other
healthcare departments and organizations.

G CGso7riIhI ClI:tDbor 1992, , _ G. _

7940 5c.,IanI Way
UaIoIDn. co USo\
(JeD) 794-4194
AllRi1hD_

ii
 137

ABOUT THE AlITHOR

FREDRICK G. ROLL IS A CERTIFIED PROTEcnON PROFESSIONAL,

CERTIFIED HEALTHCARE PROTEcnON ADMINISTRATOR, A CERTIFIED

HEALTHCARE RISK MANAGER, AND HOLDS A MASTERS DEGREE IN

SECURITY MANAGEMENT FROM WEBSTER UNIVERSITY-DENVER

GRADUATE CENTER. AT THE PRESENT TIME HE IS THE VICE

PRESIDENT-GENERAL MANAGER FOR HEALTHCARE SECURITY-USA.

PRIOR TO THIS POSITION HE WAS THE VICE PRESIDENT FOR
CONSULTING SERVICES AND THE DIRECTOR OF SECURITY FOR THE

ROCKY MOUNTAIN REGION WITH HOSPITAL SHARED SERVICES OF

COLORADO AND WAS RESPONSIBLE FOR OVER 50 FACILITIES WITH

OVER 400 SECURITY PERSONNEL. HE IS A PAST PRESIDENT OF THE

INTERNATIONAL ASSOCIATION OF HEALTHCARE SECURITY AND
SAFETY AS WELL AS A NATIONALLY KNOWN EXPERT, LEC1URER, AND
CONSULTANT ON HEALTH CARE SECURITY.

FREDRICK G. ROLL CPP, CHPA

VICE PREsIDENT-GENERAL MANAGER

HEALTHCARE SECURITY-USA
P.O. Box 3721
LITTLETON, CO 80161-3721
(303) 794-9577
FAX (303) 794-9578

iii
 138

TABLE OF CONTENTS

FOREWARD ....................... ii
About the Author . . . . . . . . . . . . . . . . . iii
Purpose of Healthcare Security Management ........ 1
[. Overview.......................................... 1
A. Functions of the Security Program . . . . . . . . . . . 2
B. Management Principles . . . . . . . . . . . . . 3
n. Organizational Role and Function . 7
Preventive Patrols and Crime Prevention . . . . . . . . . . 12
Security Programs . . . . . . . . . . . . . . . . . . . . . 14
Inter-Departmental Relationships .............. 18
III. Resources . . . . . . . . . . . . . . . . 21
Staffing Methodologies ............ 27
Security Models ..................... 30
Security Equipment . . . . . . . . . . . 36
Security Devices ................... 38
IV. Integrated Approach to Hea1thcare Security . . . . . . . . . .
40 .
Outer Perimeter Ring (Grounds) . . . . . . . . . . . . . . . .
42
Middle Perimeter Ring (Building) ........................42
Inner Perimeter Ring (Object) ........ _ ..... _ . . . . . .
43
Alarm Devices ..... _ ............................... 43
Access Control (Cards) ............ 44
Access Control (Biometrics) ........ 44
Cosed-Circuit Television (CCIV) . 45
46
Other Computerized Security Systems . . . . . . . . . . . . . . . . . .
Integrated Computer Systems ; ....... .. ...... ' .' .46
V. Risk Assessment ......................... . 49
Joint Commission for Accreditation of Hea1thcare Organizations .. 51
VI. Quality Management . . . . . . . . . . . . . . . . . . . . . .. 58
VII. The Future of Hea1thcare Security Management . . . . . . . . . . . . 64
Management in the Nineties . . . . . . . . . . . . . . . . 66
APPENDIX .......................................... 72
REFERENCES ........................................ 78
 139

HEALTHCARE SECURITYMANAGEMENT
HANDBOOK
by
Fredrick G. Roll, CPP, CHPA

PURPOSE OF HEALTHCARE SECURrIYMANAGEMENr: To provide a secure and safe

environment that allows everyone using the healthcare facility to deliver or receive quality
services with minimal threats against their personal well-being and security of their
property. Security managmtent,especiallyin the bealthcare environment, must be very
concerned with providing appropriate service for people who often require special
attention.

I. OVERVIEW
The term "security" has numerous meanings. Traditional security definitions
vary, however, Richard S. Post and Arthur A. lGngsbwy defined security in their
book Secgrity AdmWistmion: An Jnqod!yMn as "Rdated traDSlations (definitions
of security) encompassed the terms protect, shield from, guard against, render safe,
and take effective precautions against." In most definitions "safety" is closely tied
to security. Healthcare safety specifically deals with such areas as slips and falls,
hazardous and infectious wastes, as well as numerous environmental issues.
Although in some organizations security and safety are managed together, the
current trend is toward separation, as healthcare safety becomes more specialized
with the advent of various laws and specific regulatory requirements. This
handbook specifically addresses the healthcare security rather than safety issues.

Healthcare security is also becoming a more specialized field as medicine and

patient care become more complex. The need for professional, flexible, and business-
oriented security managers is becoming more evident.

Healthcare security continues to become better defined. This handbook will

address the current trends and predictions on how future developments will evolve
including the interrelationships with other healthcare departments and
organizations.
 140

A. fmM;Iigps gf the: Sccyrity Prpmm

Most security operadoDs concenttate on the prevention of aime by
taking a proactive approach vetSeS the reactive approach usually associated
with law enfo~t. Law enf~t, by its very nature, provides a
totally cIilferent function the overall protection of the public. Healthcare
security, however, spec:ializes in protecting the assets and persons utilizing
the bealthcare facilities. In most instances. 90 to 9S percent of the time of
a security officer and security III8II8ger deal with non-Iaw enfon:emeat activi
ties. Managers must understand what authorities they do have in relation
to the enforcement of rules, regulations, and applicable laws.

In order to explain the appropriate relationship of security manage

ment in a bealthcare environment, there are several basic functions that need
to be understood.

1. Scs:yrity Assessment Vulnerabilities must be identified by

conducting a security audit or security risk identification
review. This will allow for development of action plans to
reduce the threats and develop monitoring mechanisms.
2. Crime PreyentiQD Crime prevention activities must be
developed and instituted to reduce securityrelated incidents
from occurring.
3. pmooa1 Protection Protection systems must be developed to
safeguard patients, physicians, staff, visitors, and others.
4. Property Protection Protection systems musl be developed to
protect property.
S. Servicerelated Actiyities Servicerelated activities must be
identified and implemented to meet the goals, mission, and
philosophy of the institution served (i.e. parking services,
information, escorts, etc.)

2
 141

6. Enlprs;s!nu:nt - Enforcemeat aiteria must be developed and

authorized by administration to meet the philosophy of the
institution (i.e. anests, discipline, investigations, etc.)

Managers of security operations. must realize that in a1most all

instances their department is an ancillary, non-revenue-producing
department. Although very important to the well-being of the medical
facility, it is often viewed as a necessary expense by many other departments
that would prefer to use funds for dim:t patient care. This is particularly
important as bealthcare dollars become even more difficult to attain. Astute
securitymanagers must dearly identify how their department interfaces with
theotpnization, what services must be provided, and what is the most cost-
effective method to provide an environment that protects people and assets.
Security managers must undetstand the level of administtative commitment
for the program. They must dearly know their responsibilities and authority
and be prepared to meet the overall mission of the healthcare facility.

B. Manampent Princjp1es
Security managers must undetstand there is a security-related thread
that runs through each and every department and operation within a
healthcare facility. Therefore, it is necessary to work with the administration
of the hospital to establish a firm commitment of support. Once established,
the security IIUI1Ulger can work with the various departments and individuals
to identify specific risks and take preventative steps to avoid losses. The
competent security IIUI1Ulger can be a valuable resource to the institution in
overall loss prevention. This indudes accountability for equipment,
protection of high-risk patients, proper screening and selection of employees,
adequate orientation, and training of all employees. All employees need to
undetstand their involvement and responsibility for the security of the
facility, the specifics of security rules and regulations.

3
 142

'I'he.specific security management priDc:iples involved include:

1. Management must provide leadership in encouraging and

supporting security awareness and constructive preventive
measures, among all ~who work in and utilize the facility.

2. Management must solicit administrative support and commit-

ment and demonstrate the need for a strong security program.

3. Management must provide a secure working environment

which allows workers to perform their services with minimal
concern about threats to their person or property..

4. Management must assess the organization, especially property

and financial resources thatare wlnerable to misappropriation,
and provide reasonable preventive.measures.

5. Management has a special obligation to protect patients and

others who may be especially wlnerable to breaches of
security because of their medical condition, infinnity, age, sex,
or other factors.

To integrate a security program into a healthcare facility successfully, basic

management principles must be utilized. Risk Management and Security
Management have similar goals and workable principles. They share in name and
philosophy the word "management. In traditional planning, organizing, staffing,
directing and controlling associated with management, It is implied that this will be
done in a cost-effective manner. Although there are numerous definitions for "risk
management", one of the foremost experts in the field, George L. Head, Vice
President for Insurance Institute of America, stated the following definition of risk
management in his book Essentials of the Risk Mana,........,t Process. "Risk
management may be defined as the process of planning, organizing, leading and

4
 143

controDing the activities of aD organization in order to minimize the adverse effects

of accidental losses on that organization at reasonable costs.oo2

These two InII1UIFrial philosophies are cliscussed in an article which was

published in the Fall, 1988 issue of the Journal of Healtbcare Protection
Management entitled. "Safety ad Sec:udty - Ris1r. MaDapmI!Dt.. See Figure #1
page 6. The management process is described as a six step procedure.

Step I-Identify potential for loss and problems.

Step 2-Analyze potential loss or significance of problem.
Step 3-Examine all potential alternatives for viability.
Step 4-Select the best apparent technique(s).
Step 5-Implement the chosen technique.
Step 6-Monitor and improve the program.'

The anicle encouraged persons responsible for the security management

program to think like their risk management counterparts. as well as the new.breed
of healtbcare administrators.

5
 144

FIGURE #1

Identify
potential for loss
or problems

1 !
Analyze
Monitor and improve potential loss
the program or significance
of problem

1 !
Examine all
Implement the potential alternatives
chosen technique(s) for viability

1 !
Select the best
apparent technique(s)

SouRe: Journal ofHgltbcm Prptcction MarympmL Vol. 5, No. 1, Pall 1988. s.fety .. Security
+ Risk Managemmt - Ima Preftntion by Predrick G. Roll. (Publication of !he
International Auoclation for HOIPitai Security and s.tety).

6
 145

D. OIlGANIZAnONAL ROm AND PUNCTlON

Although there are numerous issues facing healthcare to4ay, security of the
patients and persons using the facilities, as well as the property of both are of
utmost importance. The American Hospital Association created an Ad Hoc
Committee on Hospital Security Issues. This committee generated a report in 1991
wbich briefly addresses the following aieas of c:oncem: Employee Impacts, Security
Forte, Violence, Drug 'Ibeft and Tampering, Theft, Infant Kidnapping and Outside
Threats, see Figure #2 on page 8. These areas certainly affect the role and function
of a healthcare security operation and must be addressed by the person responsible
.for the program.

The history of hospital security is well outlined in Hospital Security, 3rd

Edition by Russell L. Colling.4 Mr. Colling traces the organization of hospitals back
to England in A.D. 1123. The first designated security reference was known as
"Office of the Potter." This was the security manager and the "Beadles" provided the
function of stationaty guards. The modem era in the United States is summarized
as follows:

1900-1950 - Protective aspects (i.e. watch rounds and fire watch) were
pedormed by maintenance personnel. There was little mention
of specified security personnel.
1950-1960 - Shift from fire watch to law enfon:ement, with police officers
working in or out of hospitals in larger communities.
1960-1975 - The beginning of the security I1lIID8Jeme:nt era. The protective
aspects began to expand beyond dealing ' with only illegal
activities.
1975-1980 - Security and safety aspects began to join together. Managers
became more recognized.
1980s Security began to take a more expanded role in the hospital
environment. More emphasis on the protection of assets.
Greater demand for flexibility and the interface with other
team players.

7
 146

FIGURE #2

HOSPITAL SECURITY ISSUES ~

! !
1=1-1
1 ! 1
I-:l
L:::::J

_ : The American Hoopitll1_on. Ad Hoc Commi.... on Security J....... 1991

8
 147

As we travel the 1990s, the trend toward the application of professional

~t concepts and team interventions increases. Persons re5pOllSlole for
healthc:are security ~t must become business minded and approach their
respoJISI"bilities in a cost-effective, yet quality manner.

The overall role of healthcare security is to provide a proactive approach to

providing a secure and safe environment. Public law enforcement is deemed
respoJISIole for the enforcement of laws enacted to protect the general population.
Because this is very broad re5pOllSloility, this usually relates to the response to
criminal activities that have abeady oc:curred. Security, on the other band, is
usually involved in providing a specific service to a more defined organization or
poup and its primary function is to prevent incidents from 0CCIU'riDg on that
particular property. These go beyond laws since security also deals with the
prevention of breaches in rules, regulations, and policies associated with the
operation of a business. Laws may also be enforced; however, this is usually within
the same authority vested with a private citizen. Law enforcement will most likely
be called upon to deal with a violation of public law. It is essential that these two
entities work closely together to provide adequate proteetion to the citizemr of a
community.

Figure #3 on page 10 defines some of the differences often used to

differentiate between security and law enforcement.

Another interesting comparison between security and law enforcement is the

total number of personnel and doDars expended annually. The chart on page 11
(Figure #4) from the HaUgat Report II. by Cunningham. Strauchs, and Van Meter
i!lentifies the number of employees and the financial expenditures in each field in
1980, 1990 and makes projections into the year 2000.

9
 148

FIGURE #3

SECURnYlLAWENFORCEMENT COMPARISON

Security's Rple Law Enforsement's Rple

Loss Prevention ..................... Loss Rec:oveIy

Protect Specific Clients . Protect General Public

Enforcement of Rules/Regulation ... , ..... Enforcement of Laws

Prevention of Crimes ... Apprehension of Criminals

Proactive .... . ..... Reactive

SOURCE: Fredridt G. Roll

10
FIGURE #4

Private Law Tot.! I'roIectIft Pr\ftte Law

SecurIty Enfon:emeII! ServIces SecurIty ~ Tot.!
BmpIayment I!mpIc>ymeIlI BmpIayment ElpeDdilUl'el BxpendIlUreI ElpeDdilUrel
Year I CMlIIIOOII) (Mll1IoaI) (MillIons) (BiJIlonI) (BII1ioCII) (BIIIlcx.)

1980 I 1.0 0.6 1.6 $20 $14 $34

1990 1.5
....
0.6 2.1 $52 $30 $82 tc
2000 1.9 0.7 2.6 $103 S44 $147

Source: IIIIJcmt R<pon U

11
 150.

Figure #4 also indicates a treDd towwd the need for the private sector to
support the efforts.of security 'programs and recognizes that the public raourc:eswDl
continue to remain somewhat cxmstant .through the 1990s. As ctisc:ussecl eadier in
the evolution of healthcare security, law enforcement personnel are relying on
institutions such as hospitals to provide adequate levels of protection. As law
enforcement resources remain static and their responS1oilities expand with
population growth, OIpDizations such as hospitals must assume even more
responsibility for their own protection.

Hospital security must first focus on the protection of persons and secondly
on property. 1bis includes patients, physicians, staff, visitors, and others, as well
as their personal property and the assets of the hospital. In some larger and more
sophisticated hospital security operations, members of the security department may
also be involved in in-depth investigations involving computer fraud or loss of
financial assets. For the most part, however, hospital security operations involve
loss prevention including identification of potential problems that would have an
adverse financial impact upon the hospital.

PREVENTIVE PATROIS AND CRIME PREVENTION

Security loss prevention is usually accomplished through a concept called
"preventive patrol. High security visibility will act as a deterrent for most rational
persons contemplating a criminal act. Not only does this patrol provide a uniformed
security officer that is highly visible, it also verifies that conditions are as they
should be. For example, a patrolling officer may observe a door stuck open
allowing unauthorized access or find a cracked water pipe that c~ be reported for
repair before damage occurs.

Persons responsible for healthcare security must also realize that our society
includes a number of persons who are not rational and/or predictable. These
afflictions may be psychological, physiological, or neurological. People may be
affected by drugs and alcohol or be part of a group actively involved in protests
such as animal rights or antiabortion. Since some hospitals do animal research

12
 151

and/or abortions, healthcare security professionals must design an effective method

of dealing with all of these groups.

The International Association for Hea1thcare Security and Safety has been
conducting crime surveys for the past several years on hospital-related aimes.
Hospitals are not the sanctuaries they once were. People and property both are
vulDerable. Hospitals have large supplies of items used by the general public
including food, clothing, computers, and drugs. There has also been a rising trend
in infant ki~pping up until 1992. The number of female employees working
various hours has also created an increased opportunity for sexual assault.

The surveys clearly indicate that all phases of crime do, in fact, occur in
hospitals. These aimes include homicide, rape, arson, infant kidnapping, armed
robbery, assault, and theft. In one highly publicized homicide, a female physician
working in her research laboratory at Bellewe Hospital in New York was brutally
raped and murdered by a homeless vagrant in 1989. The offender was found to
have lived in a machinery area of the hospital for over a month prior to the murder.

Although the numbers and percentages of these aimes vary, hospitals in all
geographical settings from inner city to ruraI environments reported aime
OCCUJTenCe5. Persons found to be the perpetrators of these aimes included
employees, patients, and persons off the street. As a result, surveys should indicate
to security management and administrative personnel the necessity to analyze the
security risk at their facilities and take appropriate corrective action.

Iris difficult to identify specific dollar amounts attributed to theft in hospitals

since much is unreported. Hospital owned property loss is estimated to be between
$2,000 and $3,000 per bed per year on an average. Using an average of $2,500 per
year, a 300 bed hospital could lose $750,000 annually. The theft of patient
property, in addition to the dollar loss, has a tremendous impact on
customer/patient relations. Theft of employee property also negatively affects
employee moral and productivity. All of these emphasize the need to develop
extensive loss-prevention, security-related programs.

13
 152

Assaults, thefts, lddnappings, aDd other criminal incidents have led to an

epidemic of legal actions against hospitals charging inadequate security. Charges
include lack of security, too few security personnel, untrained security personnel,
improper hiring aDd retention, poor security management practices, not meeting
perceived national or community standards, aDd falling to foresee and negate
criminal activity. Hospitals by their very nature must meet the public's expectation
to provide a caring aDd protective environment. This is complicated by the fact that
healthcare dollars are becoming increasingly tighter; aDd security, a non-revenue
producing department, is becoming more costly to maintain.

SECURITY PROGRAMS
Healthcare security programs vary in size aDd complexity. The Joint Commis-
sion for Accreditation of Healthcare Organizations (JCAHO) recommends that
hospitals shall provide a security program that meets the specific needs of that
facility. In a small rural hospital, the program could consist of maintenance
personnel locking aDd unlocking doors at certain hours staff members handling
small problems, aDd the loca1law enforcement department called in for larger
problems. An adequate security program exists as long as the program meets the
needs of the facility aDd there is documentation that the program has been reviewed
and is viable in that hospital. Some small hospitals may supplement the above
program with on-site security personnel for after-hour coverage to round out their
program. Figures #5,#6, &: #1 on the following pages demonstrate potential
organizational security models in different sized organizations.

When hospitals have a formal security .program, the organizational reporting

level will also vary. In some large organizations, a Vice President for Security
Operations heads the program from a corporate perspective with individual
managers at each facility. In most medium to large hospitals, there is a Director or
Manager of Security who usually reports to an assistant administrator responsible
for several ancillary departments. In many. cases, the Manager of Security would
be considered a staff member at the level of-department head. Managers might also
have other areas of responsibility such as parking. safety,

14
 153

FIGURE #S

SMAll SECURITY DEPARTMENT

ASSISTANT ADMINISTRATOR

SECURITY SUPERVISOR
DAY SHIFT

AP'l'ERHOON
SECURITY OFFICER

MIDNIGHT
SECURITY OFFICER

Source: HosplQ) Shared Services of Colorado

15
 154

FIGURE #6

Medium to Large Security Department

Assistant Administrator

Director ot security

Safety Manager Secretary

Assistant Director

Hospiw SIwed Services of Colorado

16
FIGURE #7

Hospital Shared Services of Colorado Organization Chart

Board of Director.

Pre.ident

Executive Vice Pre.ident

Director

g:

Soum: HoIpilal 511 _ _ olC4londo

17
 156

and tnmsportadon. In large hospitals which are often located in urban or inner city
areas. security is a major responsibility that would encompass the Director's full
attendon.

At one time, security was thought of as an off-shoot of the physical plant

department, with security reporting to the plant manager_ This occurred when the
security operation was primIrily a watch-c1oclt or fire-watch service. As the
problems in security have become more complex and the responsibilities have
become greater, for the most part this concept has changed except in relatively small
fadlities. Recently howeYer, there has .been a finandally-related trend to ~

back to the plant fadlities model aDd either eliminate or reduce the security
manager's position. This is a result of organizational "flattening. This may mean
that managerial responsibility for security is transferred to another manager within
the fadlity with numerous other departments to manage.

Security managers should remember that security usually entails, among

other responsibilities, the enfOl'tement of rules, regulations, policies, and applicable
laws that safeguard the iristitution from finandal loss. These are primarily the
functions of administration, and the security department acts as its agent. The
security program should, ~. ~rt to someone in the administrative
hierarthy who understands the importance of this function and can take
appropriate administrative actions as needed. The lower the reporting level of the
security operation within the organizational structure, the greater potential for more
bureaucratic and self-servicing elements.

INTER-DEPARTMENTAL BELAllONSHXPS
The inter-departmental relationships of the security program are extremely
important. As previously mentioned, security must be part of every unit within a
healthcare fadlity. Staff members must take an active role in protecting persons
and property within their work area. At a minimum, this might be to contact
security when they see a suspicious person. Departments must also be responsible
for protecting personal and hospital property to avoid theft.

18
 157

In-depth relationships must exist between specific departments including

safety, risk management, and quality 1DII1UlgeIIleI1t. These departments are all
involved in the loss prevention aspects of a h~ital. In some departments, security
is direcdy involved with the general liability issues; whereas risk management
focuses on the insurance area, and in conjunction with quality assurance, on medical
malpractice issues. Security departments may also work closely with human
resources and employee health departments on such issues as background screening,
employee assistance, and substance abuse programs.

Although a few security departments have sworn law enforcement personnel

providing their enforcement function, most have individuals with the same
authorities as a private citizen. The latter allows for greater flexIbility when dealing
with inter-departmental issues since they can be handled administratively and not
necessarily legally.

Persons have high expectations when utilizing hospitals, including a very high
expectation of security and safety. When incidents occur such as physical and
sexual assault, theft of valuables, infant kidnappings or even the loss of eyeglaSses
or dentures. Patients and the community are disappointed and disillusioned. The
high financial awards issued in medical malpractice and inadequate security cases
reflect the public's expectation and view on this matter.

Staff members and physicians also expect a crime-free environment in which

they can concentrate on their primary function, patient care. The effect of criminal
activity or the sense of a lack of security has a major impact on the productivity and
morale of staff members.

Security officers are often called upon to perfonn security-related functions

that might offend some staff members. These might include package or locker
inspections, parking enforcement, and the enforcement of specific rules, regulations
and policies. This makes the security officers job very difficult since on one hand,
the officer is expected to be a helpful public relations representative and on the
other, the hospital's private policeman.

19
 158

EDfcm:ement actiODS Deed to be thought out in advance, coincide with the

mission and philosophy of the institution and have administrative bacldng. This is
true whether you are enforcing parking, policy or criminal violations. In addition,
the person responsible for the security function should also be familiar with the
legal authorities associated with enforcement. Are licenses required for security
personnel? Do they have authorities greater than a private citizen? When can they
legally take aedon and in what circumstances? Are there specific training
requirements for security personnel? What, if any, weapons may they use? Do they
understand the laws of arrest, search and seizure? All of these questions should be
considered when developing and managing a security department. Finding that you
did not address these issues effectively, in advance of an incident, can have a
devastating legal and financial impact.

20
 159

m. RESOURCES
In the area of human resources, exceptional character, and flexibility are
probably the greatest attn'butes either a security officer or security manager can
possess. Patients, visitors and persons within the facility have high expectation from
persons in a security unifonn. This expectation needs to be fulfilled by
demonstrating a good example of physical and moral character. Hospitals are also
extremely complex institutions performing functions ranging from high-tech
procedures to giving a helping hand. Security personnel must provide a good public
relations image while perfonning enforcement functions. Many persons entering
this field have fonner security and or law enforcement experience, while others use
this as an opportunity to gain experience to move into law enforcement positions.
The key is the ability to move from one situation to another and to handle each
equally well. In other words, an officer might be on an exterior patrol at 3:00 AM
without seeing anything but parked vehicles and locked doors for a substantial
period of time and then be called to the emergency room to confront a patient who
is "acting out." Each situation is demanding in a substantially different way.

Whether security officers are male or female, young or old, they must convey
an image that they can, in fact, fulfill a security function. Persons in a hea1thcare
setting must feel secure. This will not be the Case if the security officer does not
create this perception. This perception is often demonstrated through the ability to
communicate and the visual image the individual projects. An officer's uniform, be
it a blazer or traditional unifonn, is an outward and visible sign of authority. This
- means the officer will frequently be asked for infonnation and directions as well as
. fen: help. The ability to communicate successfully and demo~te a concern for
people goes a long way toward projecting the desired confidence.

The security manager must also be flexible. Security managers will usually
be asked to participate on a number of committees that will test their ability to
effectively and tactfully communicate. Basic management and effective human
relations skills, in conjunction with the ability to enforce policies effectively, must
be blended together for this position to be accepted in a hea1thcare environment.

21
 160

The most effective Wily for persons involved in the management of the
security program to succeed is to actively pursue and participate via a team concept.
In other words, since a number of people may be leery of the .authoritative figure
in charge of security, it is essential to have other people in the facility work with
you to develop policies and procedures.

In a paper written for an Emergency Planning class as part of the Webster

University Graduate program in Security Management, Fredrick G. Roll cited the
development of a Severe Weather Plan while being the DS:l! Director of Security at
Baptist Medical Center in Jacksonville, Florida. In this particu1ar capplication, he
utilized the resources of the Safety Committee to develop a philosophy that would
allow the various departments to ''buy into" the overall plan. By demonstrating a
commitment to the team concept this negated being cast as the "top cop" and build
a long term rapport with peers and administration.

The person in charge of the security operation must remember that

confidence must be maintained when emergency situations do occur and there is not
enough time for the t~ approach. that. the established protocols, policies and
procedures can and will be effectively implemented. In a separate paper for that
same class entitled 'Walk Softly/Carry a Big Stick", he outlined this philosophy as
follows:

Respect and confidence must be earned. Aggressive and/or

arrogant people are most often rejected, not trusted and are disliked.
The competence of a manager can best be displayed by interacting
with the various components within an organization and seeking their
input in how an emergency plan can best meet the needs of their
areas. These individual needs can then be integrated into the master
plan for overall effectiveness.

22
 161

Confidence froin the organization can most easily be gained

when the manager demonstrates the reasonableness of the planning
process. In other words. is the plan related to the overall mission of
the organization while taking into account the various needs of each
,component and meeting them whenever possible? When done
properly this interactive and participatoty management style will
allow the manager assigned the task of planning to develop and
administer an effective response to various emergency and c:tisis
situations.

Although there are numerous DIIISIIIip!lial stJIB I have _ _

that being a participating and interactive ~ providIIs the best
opportunity to 'gain the respect and CODfideDce t;4', d!oie 'RSpOIISible
for affecting a successful emergency~. ,~Is particularly
mtportant since most true.eniergencies are rare and the emergency
'manager needs to be successful before, during. and after the incident.s

ihe International Association for Healthc:are Security and Safety (IAHSS) has
developed training guidelines and certification programs to assist security officers.
supervisors and tDBDIIgers in understanding ' he8lthc8re security issues. AI the
present time, ~ are the only recognized standards ill the healtbc:are security
field. Figure #8 on page 24 contains-themurse description forme 4O-hour officers
training program. Figure #9 on page 25. outJiDes' the ~y propam, ,and
Figure #10 on page 26 desaibes the criteria DeCeSS81Yfora manapr or direetor to
achieve the designation of Certified Healthc:areProtection Administration (CHPA).

23
 162

FIGURE #8
INTERNATIONAL ASSOCIATION FOR HEALnlCARE SECURl1Y
Be SAPETY BASIC TRAINING PROGRAM RECORD

IN'I1tODUC'I1ON 1'0 HOSPITAL SBaJRITY

Hospital OrJanization . . . 1
Security u a Service Orpnization . . . . . 1
Public lind Community Relations . . . 1
Labor Relations ........ . .. ...... 1
DIM!LOPING alMMUNICAnON AND INVI!S11GAllVE SICILLS
Investigations lind InterYiews . . . . . . . . 2 + 1
Report Writing . . . . . . . . . . . . 3+2
Patrol Procedures/Techniques . , .... 3
Handling the Disturbed Patient, VISitor, Emplo)'H ... 1
Courtroom Procedures ... . '. . 1

SECURITY'S 1lOI.81N HOSP1TAL OPIRAnONS

Nuning Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Business Ollice . . . . . . 1
Pharmacy .. . 1
Dietary Service . . . . . . . . . . 1
ServiceI .... 1
PROTEC'l1VE MI!ASUIU!S
Hospital VulnerabDities . .. ... . . . '. . . 1
Lodt lind Key Systems/Access Control . ... 1
Physical Security Controls . . . 1
Alarms .. . ... .. 1
1
HOSPITAL SAP1lTY AND EMI!R.GBNCY' PREPAlU!DNI!SS
Functional safety .... ... 2
Fire Prevention . . 2
Fire Control ....... ... 2
Bomb Threats . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Disaster Control .......... '. . . . 2
Civil Disturbance ..................... 1
SECUJUTY AND nm U.w
Laws of Azrest/Search/Seizure . . . . . . . . . . . . . . 2
Narcotia and Dangerous 0nIp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Law Enforcement Liaison .... 1
SPEQAUZEI) SICILLS
Career and Professional Deftlopment . ... 1
SelfDefense .......... . . 2
Weapons: Use and Handling ........ . ... . .. ...... ... ........... 2
Emergency First AidlUfe Techniques .... . .... . .... . .. 1

MUsr TOTAL 40 HOURS _ _ (34 MANDATORY PLUS 6 ADDmONAL)

SOURCE: Tralni", C<lmml-. "'_ _ _ lion I'Gr _ 5ecurky. SoI'ety, p.o.'" 637, '-bon!,
1L601 .... (708) 953'-

24
 163

FIGURE #9

INTERNATIONAL ASSOCIATION FOR HEALTIlCARE SECURfIY

,& SAFElY SUPERVISORY TRAINING PROGRAM RECORD

SUBJECr HOURS
Introduction to Supervision 1
ContempoIazy Issues in Hea1thcare 1
SupeIvisory RespoDsibiIities 2
Employee Relaticms &: Employees Appraisals 2
Authority and Control 1
Leadership 2
Handling Complaiuts and Grievances 2
Efec:tive QiIII"".mcati~ SkiDs 2
Self IInpnm!ment 1
Civil Liability and the Supervisor 1
Safety 2
8udgetiDg/Cost Control 1
Principles of Customer Relations 1
Professionalism and Ethics 1
TOTAL 20

SOURCE: Training Comminee, IntematiolW Association for Hulthcare Security lit

Safety, P.O. Box 637, Lombard, IL 60148. (708) 953-0990

25
 164

FIGURE #10
IN'I1IRNATiONAL ASSOaATiON POll HBAL'tHCARE
SI!aJIUTY AND SAPE'IY
JIROIII!SSIONAL a!It11PICATION

Description" Purpose
'Ibis credendallna JIIOIfIIII It IDtendecI to eIICOIII'qe mel UIiIt bealthcare aecurity, Afety ancI risk III&II&JeIMIlt
administraton to continue their profesaional development IbrouJb a sauctUreCI and recognized certlftcation process.

The IAHSS credentiallnl proarun, aclminlstered by the International Healthcare Security .. Safety Foundation. consists
of prosr-ive creclentiallna Ieftb. QuaIlfied candidates are accepted into the creclentialing proarun at the nominee
lnel. Nominees prosr- to the graduate lnel to become a CertitiecI Healthcare Protection Administrator (c.H.PA)
by IUcceufu1ly passing the eumination. The third lneI (feU_) Is ~ to be developed.
NOMINI!B LEVEL
The IHSSP wt11 Issue a certlfkate conferrinsnominee statui 011 an applicant meeting the qualifying aiteria.

Eligibility
Applicant must be, have been or qualified to be a member of the aecurity/Afety risk management aclministration of a
hea1thcare fadlity.

Applicant must submit a completed application dearly documenlinJ the accumulation of the required (lO) CncIiti
among the four catqories 1isted bel_.
GRAOUATI! LEVEL
The IHSSF wt11 confer the tide of Certified Hea1thcare Prvtec:don Admlnlstrator (c.H.P.A.) on applicants succeufu1ly
completing the graduate aanUnation. Persons recemn, this certification are authorized to use the designation c.H.PA
with their name to attest to this professional creclentialing.

Candidates for the graduate lnel exam must fint have attained nominee ltatul.

Nominees must succenfully pus. written eumination covering four (4) bodies ofkpowlqe (management, security,
Afety/life Afety, and risk manapment). Preparation for the eumination Is achievoed by utilizing the study guide
provided ancI the references lilted therein.

GraduateJmnninarions
Elwninations will be administered at the winter seminar and annual membership meelinJ of the IAHSS. To arranp
other eumination times contact the IHSSP.

Each OiPA 1$ required to re-c:ertify every three yean.

SOURCE: IntemationaJ Aaodation for Healthcare Security and Safety

26
 165

Another prominent general security organization, the American Society for

Industrial Security (ASIS) maintains a management certification program that would
also reflect the competency of a secwity manager. This designation is called
Certified Protection Professional (CPP). Administtation should encourage and
reward hospital security managers who attain these certifications. Each indicates
a level of professional accomplishment. Since the CHPA and CPP require initial
testing and periodic re-certification, they also demonsttate continued commitment
to the field.

Private companies have developed training programs aimed specifically at

hea1thcare security. Communicorp, based out of Chicago, Dlinois, has produced a
number of videotapes that assist the patrol officers, supetvisors and managers with
their duties. The Private Security Television Network (PSTN), based out of
Carrollton, Texas, has recently created a unique training program designated as their
Healthcare Edition. The monthly programs are "viewer driven" as quoted by William
Jackson, President of PSTN. Subscribers to PSTN receive two videos each month.
The first video, ProForce, is a continuing education program broken into 1/2 hour
segments. This video section also has a corresponding student test to verify the
proficiency of the student, as well as serving as documentation of the training. The
second video, Security Works, contains timely information for supervisory and
management personnel on legal issues, technology advances and current issues
associated with healthcare and relevant security activities.

STAFFING MEnJODOLOGIES
The number of security personnel necessary to provide adequate security is
often discussed in courtrooms hearing litigation for "inadequate security."
Numerous people have attempted to quantify this issue based upon bed size, square
footage, acreage, number of employees, number of patient days, location of the
hospital, and other parameters. Because of the unique relationship Hospital Shared
Services of Colorado has with the shareholder hospitals it services, it is possible to
compare various data as it relates to staffing. Even with the ability to compare this

27
 166

data. no significant conclusions can be determined; however, this information is

useful for discussion purposes at each particular hospital at budget preparation time
See Figure #11 page 29.

Realistically. the proper number of security personnel should be based on the

results of a risk assessment and a miew of services rendered. . The assessment
should include such factors as the type and loc:ation of the hospital, the crime rate
of the surrounding area, the frequency and severity of past incidents in or near the
hospital, local and community standards, the function and responsibilities assigned
to the department, as well as the size and complexity of the healthcare services
rendered. The development of a security program necessitates a full review of these
factors and a periodic review to see if there have been changes that affect the
number of personnel required to perfonn the assigned tasks. However, more is not
necessarily better. Staffing levels can be adjusted upward with the expansion of a
new facility or downward if electronic devices are installed to handle some specific
tasks. In some cases, security personnel have been assigned numerous ancillary
service duties due to the lack of serious security incidents. This may mean that the
original security functions are no longer being performed compledy. A periodic
review will allow for analysis of the continuing adequacy of security staffing.

The size and complexity of a hospital obviously has a bearing on the number
of personnel and scope of the security operation. The times of coverage and the
number of personnel assigned can only be determined after a thorough review is
performed. Administrators may want to consider an outside consultant for this
purpose. Many of these consultants would be the same ~ns reviewing the
security program if litigation were to OJ:CUf. This objective, outside view can help
determine the risk potential under the current staffing plan and make appropriate
recommendations in advance of a major incident and/or litigation.

28
 167

FIGURE #11

... . auw. IID'OIIIS I nr wm-nIE .:PIII!IS I nr

...
1\
I \
} \
.. . . . . . , . . . /'\
... , .. . .
V-
/ \...
~

~ ~

PROTECTION REPORTS
sfilrrLBk~
--
.
.-
PII01ClDI IID'OIIIS I nr
1
-
_ .:PIII!IS

7\
I nr

-- j \
- t" \

-. . ., . . .
~
/'
."1 r/
"
/'-....

C
'"
/
I ,
"'-
 168

In most proprietary security ),rograms, the security personnel earn wages

somewhat above entry-level employees. Many contract security agencies often pay
their security officers at or slightly above minimum wage. In some institutions, this
may be appropriate, and in others unacceptable, based upon the scope of the
security operation responsibility.

SECURlJY MOPELS
Hospital security is being performed in a number of different ways
throughout the United States. These include proprietary, contractual, off-duty law
enforcement, and shared services security operations. Figure #12 page 31 offers
some potential advantages and disadvantages often associated with proprietary,
contract and law enforcement models.

Proprietary programs give the hospital direct selection and supervision of the
employees. This usually results in adequate training, supervision, quality control,
and direct participation in hospital activities. On the negative side, this often results
in high and escalating costs for wages and benefits. In addition to these obvious
costs, in-house programs lose sight of the hidden costs such as extra insurance costs,
recruiting, and training which are paid through other cost centers. An examination
of the total costs for a proprietary program range from 4O~100 percent over the
actual wage, see Figure #13 on page 32. In some cases, it may also be difficult to
terminate sub-standard officers. The cost effectiveness of a high paid security
management staff may also be questioned at small to medium sized facilities.

Contract security programs are usually less expensive than an in-house

program since the contractor is responsible for all wages, benefitS, insurance, and
overhead. In many cases the wages and benefits are not based on a hospital scale
and are substantially less. The hospital can calculate a fixed annual budget for the
program. Also the personnel burden remains with the contractor, meaning the
hospital can demand a replacement for marginal or inadequate officers without
liability.

30
FIGURE #12

COMPARING HOSPITAL SECURITY MODELS

IN-HOUSE PROORAM ~m4C: ~B22MM OFF-wrY POUC!!
ADVANTAGES
ADVANTAGES ADYAHTAOEJ
OIb,rol Policies
Lower Colt. PIy._1I _lau.._
Oood Tralnlo,
O>tt'roi Colt - FlIed Yeorly SIICIIOI ~ Colt - FlIed Yom, JIIICIFt
Oood Sapervtsiolt
8e11ee Admlnls,ra'iott So_ u.._',,-,!Llalooto
Oood Quolily
Qalct~. olMl1JlItllI!tn~
HJaber W.,. RI'es
Better Sc\ectloo 01 Pcnooocl Semtly Focoosed r.tuoae-o'
1.'....- 01 Spedllo HoopItoI 011_
I-"
D/S4DVANTAOU DAUWANTAoa
DlSAlWANTAOU $
OlI'-S""1OI Creep I &pensive Poor Trolal.. Pro..... ludeqaIe eo..nIt:otlons
0WrItead 0.11 Hlab Low W....; Poor Quolily Low 1-' 01 S.peMoIoo
FrI... 8cnet1. Cos' HI,h Potea.iltl 01 _ _ EIfIoatioo
ItlIdeqUl'. Supervlsloo
'l'nllnlnaCos' Hlab LIlc:It 01 Cood.ully I
LowMoraIe
Umlted Orowth OppofIunltleo Hl&ltW... Ratel I
Noc HoIpltal-Oriooted ,
ea....leations '0 Other HoIpltoil . S _ 01 CootIlaUllleallonl UmItedSecurl1)'~or_
llIIdoq ..tc _"JoIIlataat
Umlted Heoltheare Expertise
DII1JaoIt ,. Termlna'. M.rllltll 0I1J0en ....... RoactIoo - HIJItor Llabllily
Loaa-Iorra 0I1J0en "Too (bo. 10 LImIted IkIJ_ExpertIoo
~ _tIaIUtdo.~
Tood to Soot U_,1ott
--

Sour..: Hoopltol Shu.d Servic.. 01 CoIoMo

31
 170

FIGURE #13

The Total Costs for In-House Securi1y prozrams

Wages FICA
Shift Differential Pension
Training Health
Holiday Leave Workmen's Compensation
Paid Time Off Unemployment Insurance
Extended Dlness Life Insurance
Funeral Leave Dental Insurance
Jury Duty VISion Insurance
Overtime
On-call

Non-Payroll Related Expenses

Reports, Fonns, Investigations

Crime Prevention Materials Crime Prevention Programs
Unifonns Liability Insurance
Licensing Rec:tuiting Expense
Printing Cost of Payroll Expense Checks
Training Materials Supervisory Support
Depreciation of Equipment Possible Over-Staffing to Avoid Overtime
Postage Liability Exposure of Short Staff to Avoid
Office Supplies Overtime
Office Space Interview and Selection Time
Utilities Possible Unionization
Telephones

Source: Fredrick G. Roll

32
 171

On the downside, conttact agencies often pay low wages and benefits which
may attract low-quality personnel. There is often inadequate supervision, and the
officers may suffer from low morale and confusion over knowing their actual
employer. There is often high turnover which can result in a lack of proper
training. These officers may rotate from hospitals to industrial contracts and have
less of a commitment or desire to work in the hospital environment. Most conttact
agencies lack hospital specific expertise.

The Hallcrest Report II addresses proprietmy versus conttact employment in

the security field. It states, ''The Hallcrest research staff predicts that employment
in proprietmy security will experience as substantial reduction over the next 10
years; annual growth will average out to be negative by the end of the decade.
Employment in the contract service...will continue to be robust, averaging three
times the rate of growth of the total national work forre 1.2 percent".6

Some organizations have found that a combination of proprietmy supervisors

and key personnel supplemented with conttact personnel to be cost effective in
providing security for a hea1thcare facility. This can. however, still have some of
the difficulties outlined in the contractual area since the actual loyalty of the
security officers may be questionable.

The number of off-duty police officers providing hospital security functions

~ontinues to decline, except in some specific applications. The presence of a law
enforcement officer was once considered a plus by many hospital administrators.
These officers have law enforcement training and present a ~ng sense of security
to most of the public. They are also vested with the authority to make certain
arrests when a security officer could not.

Using off-duty police officers, however, has several negative components. In

some cases, law enforcement officers are not willing to perform the vast number and
assortment of security functions necessary to provide a full,.service security
operation. Secondly. off-duty law enforcement personnel have an obligation to their

33
 172

oath of office to act in their iwom c:apac:ity when they observe violatiODS of the law.
The actiODS they bike may not always be in the best interest of the hospital. In
some instances, however, it may be neces58lY to use these swom personnel for
specific: func:tiODS such as direc:ting traffic: on a city street whic:h can not be clone by
non-law-enforc:ement personnel. This is often very expensive and it is not
unc:ommon for one police offic:er to c:ost twice as much as a security officer. When
used in c:onjunction with security personnel. this can also c:reate a significant morale
issue onc:e the differenc:es in wages and responsibilities are identified.

Another security staffing c:onc:ept pining popularity is the shared servic:e, c:o-
op or hybrid model. Under this plan, more than one hospital or groups of hospitals
share the various c:omponents of a hospital security program that they c:ould not
afford independently. The c:osts of a quality hospital security administrator,
managers, supervisors, investigators, c:ommunic:ation c:enter, and equipment are
funded based upon the size, sc:ope, and usage of each member hospital. Sinc:e this
is a specific: hospital security program, the enhanced expertise in the hospital field
can be realized. Bec:ause the hospitals govern the program, usually through
representatives or board members, they have a direc:t method of c:ontrol and develop
quality similar to an in-house program, but without the higher c:osts since the wages
and benefits are outside of the direct hospital sc:ale.

On the down side of this c:onc:ept, each hospital must give up a c:ertain
amount of autonomy for the overall good of the program. If developed properly,
this program operates in the same manner as shared purchasing, linen or other
shared programs.

In any of the models, strong c:onsideration should be given to the use of part-
time personnel. By developing a mix of both full-time and part-time personnel,
adequate arid flexible c:overage c:an be maintained while minimizing the use of
overtime. Also, part-time employees are usually on a different, less expensive
benefit pac:kage. Since many programs are on a restricted or limited overtime basis,
this also lends itself to maintaining minimum staffing levels at all times. This is

34
 173

extremely important in inadequate security litigation cases. In other words, if an

incident occurs when short staffed, the excuse of not being able to use overtime can
be devastating when a judgment is awarded: The mix would, of course, VIII)' based
on the size and complexity of the security program at the particular facility.

In some hospitals, the security personnel have become commissioned law

enforcement officers or special police officeIS. The officeIS have the capability of
enforcing parking regulations under a municipal ordinance but do not have full
police poWeIS. Some hospitals, however, do have full police authority which would
allow the security personnel to enforce laws with the same authority as the local
law enforcement officers on their property. This can, in some instances, create
complications in determining what is an administrative action verses a legal action.
There may also be a question as to who holds the final authority in a situation: the
chief of police or agency granting the authority or the chief executive of the
hospital.

Although some administrators believe commissioned authority is advanta-

geous, officeIS immediately become bound by the Fourth, Fifth, Sixth and
Fourteenth Amendment of the Constitution which contain a substantial amount of
guidelines and bureaucratic complexities. Since most security operations act under
the same authority as a private citizen their responsibilities vary dramatically. In
Private Security and the Law <lwies P. Nemeth states, "In simple tenns, private
security (which includes non-commission proprietary departments) can arrest with
the same rights, reservations, liabilities, and obligations that a private citizen may.
Secondly, private security practitionen are not governed or ,restricted by the
language and interpretations of the FQ\1lth, Fifth, Sixth and Fourteenth Amendments
of the United States Constitution. This has given rise to greater flexibility and
freedom in surveillance, search, apprehension and detection of evidence and its
eventual admissibility.w7 (The Fourth Amendment deals with unreasonable search
and seizure. The Fifth Amendment deals with a penon's rights against self
incrimination. The Sixth Amendment deals with a penon's rights to a speedy trial,
right to counsel and to confront accuseIS. The Fourteenth Amendment incorporates
the equal protection clauses of the Constitution into state actions.)

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This is in 110 way intended to infer that private/proprietary security personnel

should not at all times be cognizant of an individual's rights. It does, however,
allow for more flexible perimeters and more administrative intervention from the
healthcare facility as to the control of incidents that occur within their scope. Law
enforcement personnel can always be summoned as necessary.

SECURDY EOUIPMENf
In the area of equipment, numerous systems and components are ~able
to enhance a hospital security program. It is important to remember to correctly
balance between security devices and personnel. This is discussed in detail in the
integrated security section.

A two-way radio is often referred to as the most valuable piece of equipment

a security officer can have. A two-way radio allows officers to maintain continuous
communication while moving about their patrol areas. They can be directly
summoned to situations as well as seek assistance themselves, as necessary.
Communication systems vary tremendously including paging, alarm and telephone
interface, multiple frequency radios, various sized radio units, cellular phones and
mobil or hand-held radio' units. Once the specific purpose and function is defined,
manufacturer representatives can submit proposals to meet the needs of the
healthcare facility.

Uniforms allow the security personnel to project an appropriate image to the

public. Traditional police style uniforms continue to be the most popular, with
somefacilities adopting blazers. Many of the larger institutions use a combination
of the two, with outside personnel using the full unifonn to provide a strong, highly
visible deterrent effect, while inside officers wear blazers to provide a "soft image."
The best unifonn for a specific hospital is one that meets the overall mission of the
department and the facility.

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The type of protective equipment issued to security personnel should be

based on the hospital's philosophy. Equipment could include a nightstick or baton,
handcuffs, chemical gases, electronic stunning devices, or fireanns.

The administration of the hospital must evaluate the security risk and decide
if, and what type of, weapons should be utilized by security personnel. The
institution must decide if it is more or less of a risk for the security officers to cany
weapons. In some institutions, the security personnel have been unanned until
there was a significant problem. Some have remained armed until there was a
problem involving the weapon, then disarmed.

There appears to be a broad national trend toward disarming security

personnel, including those in healthcare settings. The CWTeI1t overall sense seems
to be that the carrying of a fireann can be a greater liability than not carrying one.
However, in some facilities, weapons may be essential;

The Hallcrest Report II suggests, "With few exceptions, the 1989-1990 field
and focus group interviews with security practitioners revealed agreement that the
trend toward unanned security personnel will continue in the future. By the year
2000, the Hallcrest staff projects that Dot more than 5 percent of private security
operational personnel will be anned (fireanns) ....

At Hospital Shared Services of Colorado, which provides security coverage

for over 40 healthcare-related facilities, the percentage of armed personnel continues
to decline. As an example, in some multiple officer facilities, where all of the
security personnel at a facility were once anned, the revised model ca1Is for only
one officer to cany a firearm. This allows for bener control, yet quick response if
an anned officer is required.

In any event, the use of firearms, electric stunning devices, chemical gases,
batons, and other devices, require complete and documented initial and continued
training by competent personnel. The improper use of any weapon will immediately

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result in potential litigation. The training course, instructor, and proficiency of the
user wiD be under close scrutiny. Proper records and documentation of all training
is essential.

Training is also an extremely important element in other areas of the security

officer's responsibilities such as human relations, dealing with combative patients,
intoxicated visitors, and illegal parking by staff and visitors. Security specific
training in conjunction with the hospital's specific training needs wiD allow the
security officer to understand the overall aspects of their position in the unique
healthc:are setting. Training requirements for weapons, especially firearms, require
specific in-depth training programs. These may also be governed by rules,
regulations and laws established by local or state ordinances.

SECUROY DEVICES
Some basic security devices require constant consideration in the healthc:are
system. These include proper lighting, fences and barriers, and locking devices.
These components must be assessed regularly to assure they are providing the basis
of a sound physical security program. Failure to maintain these items properly can
in some case result in greater litigation damages since improper equipment
demonstrates that .the facility had knowledge of the need for these devices.

Crime Prevention Through Environmental Design (CPTED) is another

' component of an overall security program. CPTED is a means of reducing crime and
the fear of crime through a positive interaction of human behavior and the physical
environment. This concept allows for the integration of a number of physical,
psychological and manpower components to aid in the overall security effort.

Electronic security systems are becoming an integral part of the overall

healthcare security program. These include closed-circuit television (CC'IV), video
recorders, electric locks, card control access systems, alarms identification systems,
computer systems and robotics. These systems can be utilized independently or be
integrated into security packages. The greatest advantage of these electronic

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security systems is to augment the overall security program. This program consists
of sound physical security (i.e. locks, fences, lighting) and adequate security
personnel both in number and qUality. When properly blended, electronic security
can allow a single security officer at a stationary position to monitor and control a
number of access points and vulnerable areas of a facility. Combined with alarm
monitoring, telephone and radio communications can facilitate a cost-effective
position in the security program.

Some caution, however, needs to be considered in the area of electronic

security. Dummy or simulation CC'IV cameras have led to successful litigation
against hospitals because victims have construed that there was a higher security
level than was actually present. Litigation has also been successful when live
cameras were not monitored or had become inoperative. The use of electronic
security devices mandates careful initial financial consideration, a regular review of
the intent and purpose for the installation, and a sound maintenance program.

Hea1thcare facilities should consider developing a statement that indicates

that these systems are an augmentation and be prepared to prove that if they fail
or are out of order that there is still an adequate security program.

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w. INTEGRATED APPROAOI TO IiEALn'fCARE SECURrIY

Astute hea1thcare security managers must clearly identify how their
department interfaces with the organization, what services must be provided and
what is the most cost-effective method to maintain a safe and secure envirorunent.
Security managers must develop and understand the level of administrative
c:ommitment for the sec:urity program. They must clearly know their responsibilities
and authority and be prepared to meet the overall mission of the hea1thcare fac:ility.

Since hea1thcare fac:ilities are unique to many businesses, thesec:urity

manager or person responsible for sec:urity must identify and assess the threat levels
to the fac:ility. This is especially important in light of the increased national trend
in aimina1 ac:tivity and the epidemic level of inc:reases in litigation for inadequate
security. There is also a competitive nature among fac:ilities to provide a safe
-envirorunent to market their programs effec:tively to the patients as well as for
recruitment of staff.

Healthcare fac:ilities have numerous potential property loss vulnerabilities

suc:h as food supplies, drugs and narc:otic:s, office equipment, and computers.
Hospitals have thousands of items, either on-hand or in storage, that can be used
in other businesses or at home. Because most fac:ilities operate 24 hours per day,
there are also unique vulnerabilities present for the patients, staff and visitors unless
appropriate safeguards are established and implemented.

Persons responsible for healthc:are sec:urity must work with the administration
and eac:h and every department of the healthcare fac:ility to establish a firm
c:ommitment of support. Once established, the security tnBIlIlgE!r can work with the
various departments and individuals to identify specific risks and take appropriate
preventive steps to avoid losses and injuries. These would include accountability
of equipment, protection of high-risk patients, proper screening and selection of
employees, adequate orientation and training of all employees regarding their
involvement and responsibility for the sec:urity of the fac:ility, the specific:s of
security rules and regulations as well as a guide for disciplinary action and
enforcement.

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Each healthcare facility must identify how the security function will operate.
Very small facilities may not have specific security personnel, but must identify and
develop a security program. In other words, they must develop mec:hanisms using
available resources to address security issues. Very large organizations may have
a director or administrative personnel running their security programs with over a
hundred security officers. The majority, however, fall somewhere in between.

In order to maximize the overall effectiveness of the security effort, 'many

departments are utilizing physical and electronic measures. These measures, when
integrated with security officers, can provide a more comprehensive security
program.

In too many instances the security aspects of a project under construction or

a facility being renovated are reviewed after the work is complete or after security
problems have developed. Security considerations must play an active role in
planning all projects. Often security is viewed as being on the opposite end of the
spectrum from convenience. In other words, a well fortified campus with fences,
gates. locks and multiple barriers may be great security devices. however, aeate a
great deal of inconvenience for the users.

Hea1thcare facilities are usually marketed as remaining open 24 hours per

day. available to the public and friendly places for people to come. "Open visitation"
can become a security manager's nightmare. The ability to design and implement
adequate security measures with minimal inconvenience starts during the planning
stage of construction and renovation. Persons responsible for security management
or security consultants should be asked for their input at the planning and design
stage. Installation of systems at the time of construction is less costly than change
orders or retrofit. In many cases, it may be possible to at least pull extra wire
which will allow for the installation of future security devices in a more cost-
effective manner.

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Comprehensive protection can best be provided by developing a series of

multi-barrier protective devices. The overall protective system is usually defined as
a series of protective rings. These rings consist of a perimeter ring which is at the
outer most portion of the property, the secondary ring is usually the perimeter of
the building, and the inner ring which is usually the interior or the area immediately
in proximity of the object to be protected. Given today's technology for sources of
protection, it is now possible through physical, electronic and computer
enhancements to aid security personnel with the assigned task of providing
protection to persons as well as assets.

OUTER PERIMETER RING (GROUNDS)

The perimeter of a facility can be protected in a number of methods. These
typically include barriers which can be either natural or man-made. Natural barriers
include lakes, rivers, mountains, heavy thick bushes. Man-made barriers usually
deal with fencing. Fencing at a minimum will usually put people on notice that the
occupants have clearly delineated that this property is off limits. This may or may
not also include signage which is considered as a passive device to clarify this
position.

To augment perimeter protection there are a number of alarm techniques

available. These include fence vibration alarms, fence disturbance alarms, electronic
capacitance sensors, pressure sensitive sensors, motion detectors, photoelecmc
beams, microwave sensors, heat sensors, all of which can be the sensing device for
an alarm system. Alarm systems traditionally consist of a sensor. a transmission
device and an annunciator. The sensor detects a change, the transmission device
is the medium that communicates to the annunciator which reads and assimilates
the information received.

MIDDLE PERIMETER RING (BUILDING)

In order to protect a building's perimeter effectively security personnel must
remember all sides of a building have a certain vulnerability to attack: Doors,
windows, and openings are always vulnerable, but in addition walls, ceilings, floors
and roofs need to be considered as possible means of access.

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A number of a1ami devices are available to address these various

vulnerabilities of an attack. These devices inciude contacts on doors and windows,
fon and glass break sensors for windows, and vibration alanns.

INNER PERIMETER BING COBJECO

Once inside pressure sensitive devices, photoelectric, motion detection, heat
sensors, sound detection, wall vibration, microwave, capacitance sensors, and other
devices can be used to detect intruders. Many of these devices can be utilized in
dual capacity that work together as a check and balance to negate false alanns.
They also work together to identify intrusion if one of the two systems are defeated.

All three areas can be monitored by various types of standard alann systems.
Standard enhancements to the protection of these areas can be accomplished by
providing adequate lighting, locks and keys, environmental security design features,
duress buttons, security patrols, closed circuit television systems, fastening locking
devices to articles, electronic locking devices.

ALARM DEVICES
As technology continues to develop many alann devices are taking on
computer enhancements which have the capability of poling the various sensing
devices on a regular basis and immediately registering either an alarm, if activated,
or registering a trouble alarm if no response is received. Computers or microproces-
sors have the ability to measure both the existing conditions and changes. Through
programming, perimeters or tolerances can be established for the sensing devices to
measure. This can help reduce the number of false alanns which continues to be
one of the greatest problems in the alarm industry.

Current computerized alarm software packages can stand alone or be a

component of a card-control access system. Computerized software packages allow
for the monitoring of thousands of alarm points, automatic display capabilities,
automatic arming and disarming of systems, time control windows, alann review of
priority, systems reports, automatic telephone notification as progranuned. One of

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the greatest advantages to the computerized alarm enhancement is that numerous

manual tasks that fonnerly required operator action and intervention can now be
handled by the computer.

ACCESS CONTROL (CARPS)

Card-control access evolved from a card and manual punch technology in the
19505, to the current status of computer and software enhanced systems with
various methods of validating and authorizing access. Whether the system is what
we consider today a simple card system or a more sophisticated biometrics device,
the heart of the system is computer based. Card access systems require an encoding
device, a reader, a locking mechanism, and a processor. The sensor extracts the
infonnation from the card and the reader translates the infonnation via a code. The
infonnation is transmitted to the computer for comparison against the progranuned
data authorized and stored. Based upon the programming, access is either granted
or denied. There are also numerous variations of the actions taken by different
systems but virtually all record the transactions for documentation purposes. Most
systems also have alarming capability from unauthorized card usage to standard
alarm monitoring.

Card technology consists of magnetic cards (magnetic coding), Weigand cards

(coded magnetic wires), magnetic dot cards (coded magnetic dots), optical cards
(coded light patterns), and proximity cards (coded radio frequencies). These cards
are designed to interface with specific card readers.

Smart cards contain a micro processor and coded memory. This allows the
card to have personal identification codes. These systems operate from either
random access memory (RAM) or read only memory (ROM). Also they work only
in conjunction with smart readers thus raising the cost of these advanced systems.

ACCESS CONTROL (BIOMETRICS)

Comparisons of physical characteristics is the basis for biometric access
control. This is defined in James Arlin Cooper's book Computer and

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Communications Security as follows; "1'bI!re are c:urrendy seven relatively successful

biomeaics techniques in use. These are:

1. Signature recognition.
2. Fingerprint recognition. ..
3. Palmprint recognition. ..
4. Hand-geometry recognition.
S. Voice print recognition. .
6. Eye retina panern recognition. ..
7. Typing rhythm recognition. .to9

The basis for these biometrics systems is the comparison of the data being
read with the data stored in the computer data bank. The software package after
comparison either allows or denies access.

CLOSED-CIRCUIT TEl.E\IlSION CCCTV)

Closed-circ:uit television has been a basic security device for a number of
years. A basic CCIV system consists of a lens, camera, transmission medium, and
a monitor. Variations to the basic system include, housings, pan tilt and zoom
mechanisms, switchers, quad ~, digital screens, scanning devices, loping -
bridging devices, motion detectors, time lapse video recorders.

Computer enhanced CCIV systems are now in use on a fairly widespread

basis. Some systems utilize MS-DOS operating software to integrate the various
systems and components found in complex CCIV systems. V18)'rogramming the
operator can pre-set the sequencing of the various monitors, by pass when desired
and manage multiple cameras and associated devices. In one system a camera is
focused on a specific heavily-used exit. The adjacent stairway however, is protected
via a motion detector which, when activated, allows the computer to direct the
camera to pan. tilt and refocus the camera to view the exit, record as well as alert
the dispatcher, via an alarm.

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Compressed video imaging continues to become refined. These systems allow

for transmission via telephone lines thus e1imitulting the costly requirement of
c:oaxial cable, fiber optics and the heavy expense of installation. Radio Frequency
(RF) or wireless systems are also available to negate installation costs, however, are
they initially expensive. These do have tremendous applications in covert situations.

01HER COMPUTRIZEQ SECURllY sysTEMS

In addition to the above mentioned systems, computers canalso be used to
lock and unlock doors on pre-program schedules elec:tronic:ally without a physical
response from security personnel. Computerized guard patrol or watch patrol
systems can specify the exact tour a guard should take. The tour can be tracked and
verified. If the proper rounds are not met, the computer can notify the operator
with an alarm that the perimeters of the checks are not being met or that the guard
may be in need of assistance. Event messages can also be sent to the stations to
provide the security officer with specific guard directions.

Electronic mail can be used as a security device in certain c:irc:umstances.

Breaches in security, suspicious persondesaiptions and sec:urityinc:ident notification
can be sent over the "E-mail" system -to the "need to know" people without
unnecessarily notifying or alerting others or the public.

Photo identification systems are now becoming computerized using digital

imaging devices. With these systems it is possible to capture and store images,
signatures and vital data on employees and have instant rec:all. These systems are
valuable for comparative recognition and allow for the creation of a replacement
card without the employee being present.

INTEGRATED COMPlITER sysIEMS

Various security devices can be computer enhanced so that their individual
capabilities can be more effective.' The greatest benefit to computer enhancement
is the ability to integrate and interface the various sec:urity components to maximize
the overallsecurity program. This allows for more than one component to work in
concert with other devices and provide a more comprehensive system.

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The possibility exists to integrate a 1lU1Dber of independent systems in a

facility including security, safety, and maintenance. From a security-related
perspective alanns, CCIV, access control, guard tour, and photo imaging are capable
of being interfaced with the appropriate central processing unit and software
programs. Some' security professionals are not totally comfortable with a total
integration and feel this is "putting all of your eggs in one basket. Many prefer
partial integration and partial separation. However, as the reliability and comfort
level inc:reases more integration and consolidation will develop. The capabilities of
a single person (or more in large operations) at one central control point are greatly
enhanced when he or she can monitor alarms, CCIV, guard tours, intercoms,
identification sYStems. As these responsibilities become greater and more complex,
computer enhancement is essential.

Artificial intelligence is also now available which allows, through computer

based software, options and directions for the operator to take in the event that
various circumstances occur to assist in assuring a successfull outcome to the
incident. The computer can also be programmed so that more normal types of
activities can automatically be handled by the computer without operator
intervention.

In any case, the healthcare facility that utilizes electronic components to

enhance its security program should consider developing a statement of purpose
defining the scope of the system(s). In other words, it should be clear that the
sYStem(s) IYi!nmI the overall security program in advance of an adverse incident
in which it could be construed that these sYStem(s) provided a foolproof or
guaranteed security program.

It is also extremely important to develop a preventative maintenance plan

and service agreement to insure that the sYStem is functioning at all times.
Electronic and computer sYStems that do not function as designed or are not
properly maintained, may from a litigation sense, be potentially more damaging
than no sYStem.

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Security can be enhailc:ed in a healthcare facility in a number of ways but

must be aware of existing vulnerabilities and explore how they can be addressed.
The security program can include a number of physical and electronic components,
however, a predetermined appropriate response by persons respoDS1"le for security
is necessary to provide for a comprehensive, integrated security system.
 187

v. RISK ASSESSMENT
For healthcare security "managers to assess their unique security needs, they
must first define what they are attempting to protect. The patient, staff, visitors,
physical assets, the institution's name, are usually vital areas of concern. Although
each facility may list their priorities differently, most will probably agree with the
patient being first.

Once the overall assets and other areas of concern are identified, the next
step is to determine the potential threats that may exist which can create an adverse
effect on the organization. As previously discussed, the International Association
for Hea1thcare Security and Safety has conducted surveys of member hea1thcare
facilities to determine what crimes and to what extent, occur throughout the United
States and Canada. All reporting hospitals have indicated that they had various
levels of crime occur on their property regardless of whether they were inner-city,
urban or rural. This along with the fact that healthcare facilities do not operate in
a vacuum, as crime continues to exist throughout society, should place healthcare
security managers and administrators on notice that security threats and incidents
do exist and occur.

Next an identification of the vulnerabilities must be conducted. This will

allow the appropriate persons at the healthcare facility to make the appropriate
action plans to address these vulnerabilities or, if they so choose, consider what
risks they are willing to take in lieu of the changes.

After the assessment of what is to be protected, addressing what the threats

exist and either how to develop action plans to address the vulnerabilities or what
risk they are willing to take, a monitoring process needs to take place. This process
should be conducted on a regular basis possIbly every six months or at least once
a year to assure a safe and secure environment. In the event of significant changes
either to the types of patients seen (possibly adding a psychiatric unit), or major
additions to the facility, you may choose to conduct another total assessment to
determine how these changes may impact the overall security program.

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Assessments or risk ai1.alysis should be conducted for 8 variety of reasons.

In his book Effectiye Security Management. Second Edition, Charles Sennewald
states, "The eventual goal of risk analysis is to sttike an economic balance between
the impact of risk on the enterprise and the cost of protective measures. A properly
perfonned risk analysis has many benefits, a few of which are:

The analysis will show the current security posture (profile) of the
organization.
It will highlight areas where greater (or lesser) security is needed.
It will help to assemble some of the facts needed for the development
and justification .of cost effective countermeasures (safeguards).
It will serve to increase security awareness by assessing the strengths
and weaknesses of the security to all organizational levels from
management to operations."IO

When it is determined that a risk analysis or a security survey should be

CondUllted Richard Post and Arthur Kingsbury suggest in their book. ~
Administration, "An understanding of the planning process prior to and during a
SUlVey is essential for success. Consequently, general management planning
processes should be considered in preparing a workable SUlVey instrument. The
traditional steps in planning include:

1) Recognizing a need
2) Stating objectives
3) Gathering significant/relevant data
4) Developing alternatives
5) Preparing a course of action
6) Analyzing the plan
7) Reviewing the plan
8) Implementing the plan"lI

Note: This writer would add a ninth step: Monitor the plan for improvement.

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At this point asecurity maDager or administrator might question whether such

a process is worth the time and effort. In Ayoiding Liability In. Pn:miscs Security.
a case called Thomas C. Roettger and Diane D. Roettger v. United Hospitals of St.
Paul, Inc. is discussed. This case deals with an assault on Diane Roettger while she
was hospitalized by an individual named Charles Brown. Brown was a trespasser
and had been loitering in the hospital on at least three other occasions. Diane
Roettger was awarded $300,000 and her husband, Thomas $22,500 in the case.
The important significance to this case can be summarized in the commentary:

This case once again illusttates the need for continuing assessment and
reassessment of the security needs of a particular business or
enterprise. When one or more individuals has been found to breach
the existing security measures, then that in and of itself should give
rise to a reevaluation of the effectiveness of the security measures
being utilized. Repeated breaches should alert security personnel (or
persons responsible for security) that the measures being employed are
insufficient and immediate steps should be taken to in order to prevent
future breaches of security.. 12

JOINT COMMISSION FOR ACCREDITATION Of HEALTIiCARE ORGANIZATIONS

Another reason for healthcare facilities to conduct security risk assessments is to
maintain accreditation. The Joint Commission for Accreditation of Hea1thcare
Organizations (JCAHO) is an accreditation body that allows. for voluntary
inspections of healthcare facilities to review standards/guidelines compliance. In the
past ten years there has been a variety of changes in the way security has been
reviewed as part of this process. These changes have evolved to the current level,
which many feel is inadequate in terms of security specific standards, however,
interpretations can be made of the existing standardslguide1ines to develop effective
healthcare security programs.

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The history of JCAHO is desaibed by Russell L. Colling in his third edition of

Hospital Security. Mr. Colling stated that the beginning of the organization can be
traced to the American College of Surgeons in 1917 with the formal beginning of
the Commission in 1951. The current structure was formulated in 1979. At that
time the organization was known as the Joint Commission on Acc:reditation of
Hospitals (JCAH).

Although there has been numerous changes in the Joint Commission over the
years, two recent changes are notably significant. In August of 1987 the name of
the organization was changed to the Joint Commission for Accreditation of
Hea1thcare Organizations to demonstrate the expanded role of hea1thcare
organizations over hospitals. A second major change which became effective in
1988 was the development of the KIPS scoring process. KIPS stands for key items,
probes and scoring and is described in the 1991 Accreditation Manual, under the
Plant Technology and Safety Management (PTSM) section, as:

The key items, probes and scoring (KIPS) document outlines the process that
the Joint Commission will use to evaluate compliance with the safety
management standard. It is important to note that the process is interactive.
It is designed to involve any appropriate staff member in the survey process
to evaluate how well information has been transmitted and retained. Such an
approach assumes that the development and transmission of information about
the environment is a key function of management. Transmission of
information, coupled with astute analysis and measurement of change, is
assumed to stimulate the continuous improvement of the manaJement of the
care environment.1I

KIPS utilizes the key items as the key factors in the acc:reditation process. The
probes then become the questions that are asked to identify if the key items are in
fact addressed and the scoring is just that, a method of judging the level of
compliance.

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In the area of security there have also been a number of significant changes. For
example, ten years ago the 1982 Accreditation Manual for Hospitals listed specific
guidelines regarding security. Although brief they did list some basic components
that hospitals should consider. At the time these guidelines were a component of
the Punctional Safety and Sanitation section of the Accreditation Manual for
Hospitals:

~ Measures shall be taken to provide security for patients, personnel,

and the public, consistent with the conditions and risks inherent in the
hospital's location. When used, these measures shall be uniformly applied.
Based on administrative decision, these measures may include, but are not
necessarily limited to, the following:

Effective screening and observation of new employees.

Identification badges for all hospital personnel.
Exit/entry control, includlng good lighting.
Internal traffic control, including the use of visitor passes.
A wrinen plan for managing bomb threats or civil disturbances.
This plan should be coordinated with. and may be a part of,
the hospital's internal disaster and evacuation plan.
Use of security guards.
Package control, to deter theft and to prevent introduction of
unauthorized items.
Well-lighted walkways and employee and visitor parking areas.
Use of surveillance equipment such as visual ~nitors (mirrors
and closed-circuit television) and a1ann systems.
Management of prisoner-patients as required.]4

Under this format you will note that this particular approach allows for a great
deal of latitude and interpretation in evaluating the security programs in hospitals.

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In the mid 1980's the Commission dropped the specific guidelines for security as
the manual began to be used more for self Lqessment purposes. The material
began to address security as part of safety management as the PTSM section became
a stronger component of this overall survey process. In 1986, for example, the
guidelines were reduced to "PL.3.1.7 a program that is designed to protect human
and capital resources and that is consistent with the conditions and risks inherent
in the facility. nJS

Members of the International Association for Hospital Security (IAHS) [note the
name Was change to the International Association for Hea1thc:are Security and Safety
(lAHSS) in 1989] made an attempt to have the Joint Commission adopt specific
security standards in 1987. Unfortunately the expectations of IAHS fell short of
being adopted. This was described in the September 1988 issue of HOSj)ital Sec:urity
and Safety Management:

The IAHS submitted guidelines, only to have them deleted by a committee of

the Joint Commission, which considered the material "too presaiptive, says
Ode Kcil, Director of Plant and Technology Management. Even the one
statement on security that had existed in the Joint Commission's accreditation
manual is no longer there.

PL.19.11, no longer included, read: "There are security measures for patients,
personnel and the public consistent with the conditions and risks inherent in
the location of the hospital." But the updated PL.l.3.2 c:alls only for "a risk-
assessment program," which K&:il says includes security.

"It doesn't say security program. That's implied," says David Bushelle,
Assistant Director of Corporate Relations for JCAHO. ''It's just common sense
for people c:harged with safety responsibilities to be aware of individual
security needs of their organizations."J'

54
 193

Another reason for conducting security asSessments is outlined in the 1992 Joint
Commimon of Healthcare <>rPmzations, Accreditation Manual for Hospitals Volume
n Scoring Guidelines:

(PL.1.2.2 a risk-assessment program that evaluates the impact on

patient care and safety of the buildings, grounds, equipment,
occupants, and internal physical systems;

PROBES is there a riskassessment program that .includes:

a. a security program that addresses c:oncems regarding

patients, visitors, personnel, and property?
b. reporting to the safety committee, at least quarterly,
-sec:urityincidents involving employees/patients? and,
c. reponing to appropriateindMduals, at least quarterly,
the safety committee's conclusions, RCOIIIJltendations,
actions taken, and monitored effectiveness of actions
taken?
NOTE: 'lbe security program also jncludcs policies and prpcedurcs for
appropriately identifying aU patients. hospital staff. and yisitors. 17

In April of 1992 the JCAHO's Standards and Survey Procedures Committee

endorsed the revised standards. In the August 1992 issue of Health Fac:iljties
Management, V. James McLamey states that:

Although Standard PL.1.2.2 requires healthcare facilities to set up risk

assessment programs, requirements for security programs are addressed
only in the JCAHO's survey scoring guidelines. JCAHO staff thus
recommended that security and risk-assessment requirements be
separated into two distinct standards - PL.l.2.2.1 and PL.l.2.2.2
respectively - eaclJ with its own set of scoring guidelines.

ss
 194

Sec:tirity;
PL.l.2. The safety-JII81UIgerDent program is based on monitoring aDd
evaluation of organizational experience, applicable law and regulation,
and accepted practice aDd includes:
PL.1.2.1 policies and procedure for safety in all
departments/services;
PL.l.2.2.2. a risk assessment program that PL.1.2.2.1 evaluates
the impact on patient care and safety of the buildings, grounds,
equipment, occupants and internal physical systems;
PL.l.2.2.2 includes policies and procedures for a security-
management program. JI

Numerous methodologies are available to conduct risk or security assessments.

In some cases a facility may need to bring in a professional hospital security
consultant to provide an objective outside review. Another possibility however may
be to develop a multidisciplinary team for the purpose of conducting this review.
A multidiscipliruuy team that is familiar with the facility should also be familiar with
the mission of the organization and be able to view the security-related issues in a
non-bias manner. This should also reduce the pos5J"bility of specific security related
requests by the security manager or administrator responsible for security, as self-
serving.

The Appendix contains a sample format. The intent of this process is to allow
for Annual Risk Identification/Security Analysis, Risk Action Plans and a Security
Abatement/Monitoring Review. This three step process will also ,provide adequate
documentation demonstrating your efforts to take assertive steps to identify and
reduce the likelihood of security-related incidents. This format bas also helped some
hospitals identify specific security-related issues that require professional outside
security conSultant assistance or other methods of corrective action.

S6
 195

Each healthcare facility must understand that the potential for adverse security-
related incidents does exist. A proactive approach which consists of the
identification, abatement measures and a review process needs to be conducted and
documented. Although there is no guarantee that these actions will negate incidents
or litigation, your defense posture should be strengthened.

The fOllawingis the 1994 JCAHO Security Standard:

1'1. 1.1.2.2 m. ,.,." _so I J , " . . . if __ III . . . , . , . . . . . . . , ,1 ",...1i1IIIII

............ "'" 'inI ,.,..,. "'" -i,,. ".etit:r-1tId idIIu , IiIk - r . " . . . ,
tItMJ . . . .".., IIII,,---Ir, -*r ""'-''''''''''
PROBES Do policies and procedures include
a. a security management program addressing concerns regarding patients,
visitors, personnel, and propertyl .
b. information regarding security incidents invol~ing patients, visitors, Staff
and hospital property shall lie reported to the Safety Committee every
~rRKWrth. .
c. information regarding security iOCIdents involving patients, visitors, staff
or hospital property having lieen reported to the Safety Committee, the
recommeadatilll!s, action plans and outcomes of the efforts of the Safety
Committee ShoulO be reported to the appropriate management personnel
on a Quarterly basis.
d. provisions for identifyin& as appropriate, all patients, hospital staff, and
visitorsl
e. provisions for access control to sensitive areas defined by the security
management program? _
f. a directive from the chief executive officer or designee designating the
specific personnef responsible for security? arid
g. provisions for orientatiOn (QI' all personnel and at least annual continuing
education of personnel in those areas determined to be sensitive by the
security managementprograml
No_; For probe e. nnai1ive .... may Include. but ere not limited
to. emergency cere .r.... newborn nurnri... end ph.rmllCi...
SCORING
score 1 a-g
score 2 any 6
Score 3 any40rS
SCOre 4 any 2 or 3
SCOre 5 none or any 1
Notes; To receive cr.dit for probes b. end c. the minimum number of
required reports mUlt be eveileble.

Reviled 694

57
 196

Be.l~C.re Security USA

1996 JCABO SBCf1RI'IT I'llRI'ORJIANCB

BVALUATION
OVDVIBIf AND ASSBSSJDlN'l' TOOL

Attached. i . a lI,JtD~ic of .ecurity ,aDd. related info~tiOl1

cOI1ta1oed 10 the Jo1ot Ccaai iOl1 011 Accred.itatiOl1 for Bealthcare
OrganbatiOl18 1996 CQIIIIJ'ehenc"re AacracUt;,eUQD NaDUel. The 10tent
of the ~t i . to provide en overvi_ of the 1"6 JCABO
8tendard8 _ they apply to the individual re8pOl18ible for .ecurity
rvic... ID . , . t faci1iti.. the individual re8pOl181ble for
curity will follow vbatever iD.8titutiODal d ign i . formulated.
to addr the global i u which .ff.ct all deparc..nt.. Thi.
8}'D.OP818 will provide a hadc UDd.r.taDdiDg of the JCABO philo.ophy
r.gardiDg the perfo~ce focu..d evaluatiOl1 proc.... Tb.re are
al.o ep.cific referenc.. _de to the are.. dir.ctly .ddreing
h.alth care curity i.aue.. The final portiOl1 of thi. doc:ueIent i.
en _ t tool outliniDg .tendarda effectillg the curity-
rel.ted i ue. aDd. l.ct ar.a. that will require .ctiOl1 by the
individual r.8pOD.1bl. for curity rvic... It i . rec~ded
that the entire 11195 C"'Iprehen,"re Accredit.aUQD ........1 ha revi~
end that thi. eynop.i. b. u.ed a. r.f.renc.. '

1'"
cOlllpOlleDt. and muad.ate. iD the
.war.
The _ t tool i . d igned a. _y to al.rt p.r.0D.8
r.8pOI18ible for curity rvic.. to b. of ep.cific
Stendarda and provide _thod
to document complienc.. Are.. of non-complianc. .hould be
di.cud with .ppropriate curity profe iODal., ri.k manager.,
leg.l council, and .dlllini.tr.tor.. R.levant countermea.ur or
r.a.on. for non-complianc. .hould b. documented in advance of an
iDcident or 1nep.ction, not aft.rward

If you have any qua.tiOl18 regardiDg the 1ofo~tion cont.ined

in thi. 'yDop.i., r.vi_ the 1996 CCl!!!IPTehendytl Accredit.tion
1IamJal. Que.t~OI18 cc:mc.rD.iDg the u.e of the PyDop.i. or the .elf-
.-nt t~l _y ha dir.ct.d to Predrick Q. Roll, Vice
Pre.ideDt-Qenera1 KaDag.r, B1thCare S.curity USA, at (800)-866-
'577 or (303)-794-9577. Pax (303)-794-9578.
 197

1996JCAHO SECURITY PERFORMANCE

EVALUATlON OVERVIEW

PHILOSOPlUCAL OVERVIEW

The 1996 staDdards IDd evaluation metbodology IIR very similar to the 1995 process. In other
words, institutiom with alOUDd 1995 Security Managemeut Program will have only minor
1djus1ments to comply with the 1996 format. Many of the pbiIoIophic:al processes have remaiDed
in place IDd an over view of the 1996 security related matcriaI is listed below:

Stable staDdards form a framework that describes the eveolUll basic foundation for
providiDg quality care and CODtinuously improving that care over a period of time.
StaDdards IIR perfOrJIIIIICC- based IDd functioDally orpnized.
Ougoing perfOrJlllllCC-improvemeDt activities should be developed.
Ongoq performaDl:e-effolt across the orpDizatiOD is the key to enbancing the qua1ity
and value of the bealth care scrvic:e.

The survey process focuses on the performance of patient-foc:used IDd organizational

functions that support quality patient care. Emphasis is pIKed on observIIioD of
performance IDd interviews with IIaff IDd patients.
The framework for improviDa performm:e will beevaluared.
The orJanization's reladoDsbip with its exta1III environment is important.
The orpnization's inrernaI c:baradaistic mI functions IIR important.
A method for systematically assessing IDd improving imponanl functions IDd work
processes IDd their outcomes need to be inpJace.
Self evaluation should c:oadIIJe to be viewed u major opponunity for rpntjDlOIJI
improvement.
Standards sbouId CODliDJe to emphasize acmaI performance, DOt simply the capacity to
perform.
The performance expectalions reflected in the staDdards should be set forth in a quality
improvement context. 1bat goal js excellc:!U care that MlltjmlCS to improve oyer time

 198

of important ~-foc:used IDIl orpDizIIIiooal ftmctions !bat support quality patieDl care,
rather than evaluating activities that may have been conducted primarily to pass tile survey.
Utilize a mc:tbodoJogy for sysrcmatical))' assessing am improving impnrtam f!J!x:tions am
work processes ,00 !heir IJ1trmnc:s Tbe improvement cycle is applicable at all levels of
the organization. Tbe improvement cycle flows in tile following 1IlIUUIer:

DEsIG!!I refers to tile rational, deliberate process of creating a quality service as

viewed by those who receive it IDIl provides opportunities to build into tile service
or product the demonstration of performance described as follows:
MlWillBlWEI!iI]r-Jinvolves both routine, ongoing data collection for processes or
functions performed . ividuals or multi-disciplinary teams or groups, as well
as time specific, focused da ~lection.

4ClSF<!SM!1\P1' of tile data to draw ~iom about current performance IDIl decide
whether to pursue an opportunity for .vement or resolution of a problem.
'-,
Statistical analysis IDIl other quality improv~ls are often useful including
comparative data. '~,
",

Perfonnance IMpRQyEMENT ICtivities should be devel~ prioritized. Tbese

may include a process to test a new approach, coUecting data ~t its effects, IDIl
take action to standardize tile improvement or repeat tile process if results are not
satisfactory .
REDESIGN of tile existing function or process or an innovation based on tile design
of a new approach aimed at meeting or exceeding needs or expectations.
Site examples of implementation, outline strategies, activities, and/or processes that you
may use to meet tile intent of tile standards. You are encouraged to be innovative in your
approach to meeting tile intent of tile standards.
Examples of evidence of performance provide insight into what sources a surveyor may
seek evidence from or that you may present to a surveyor to show that your organization
complies with the intent of tile standard(s).

3
 199

patient Rights and OrpnizptlooaJ Ethics (overview)

The ,OIl of Ibis fuDCIioD is to help improve patieDl outcomes. Respect each pedear's personal
dipity. provide coasiderll, respecdW care: focusecI on the patiem's iDdividual needs. Security
persmmel DIUIt UDdenIaDd IJIII be prepued to verbalize tbal patieDts have a ri&ht to reuouable
security while in the beaIth care: facility.
RI.1 The bospital addreued ethical issues in providiDg patiem care:.
Intc:nI of HI 1

The patiem's ~ to security IJIII personal privacy IJIII coafideDtiaIjty of information.

RI. 1.3.3 The bospiIIl dcuautr. . respect for the foUowm, pItieDt needs; security (not 1COI"ed).

_I", __
ICIIJlICtl- ----~_-
1-1 __'I------...,
_

~I=I ____-_....J
This flow c:bart iIJusttata the procell for iaJproviDc pcrformaace IJIII outcomes in a beaIth care:
organization. The tompOIICID of the pcrformaace-improvaDeDl cycle an: COIIIICded by the
actions of orgaDizaIioDaIladers, JIJIIIIPrS. physiciaDs mI other c:liDicl.ms, 1nISIcCS, mI support
sraffwbo ....... ~ - ,..... ~tbeir - " pnCIIIII.
The performaDce-hqxovemem cycle d&:picIed in this flow c:bart bas 110 be&ilQliDi mllIO ead. An
orpnizaIioa may stari ill impovemem e1fort at my point: by desipinJ a DeW service; by flow
chaning an existing c:IinicaI process; by measuriD& palieDt outcomes; by comparinJ ill
perfOI1lWlCe to tbal of other orpDizatioDs; by scIccting specific areas for priority atICIIIion; or
even by cxperimenIiDg willl DeW _ys of carrying out c:uneDl ftmctioDS.
 200

PLAN
PL.I The organization has a planned, systematic, hospitalwide approach to process design, aDd
performance measurement, assessment and improvement.

PL.2 New processes are designed well.

MEASJIRE

PL.3 Data is systematically collected.

AsSFSi
PL.4 The hospital has a systematic process to assess collected data.
IMPROVE
PL.S The hospital systematically improves its perfol1l18DCC.

When designing a new process, redesigning an existing process, or deciding to act on an

opportunity for incremental improvement in an existing process, the organization has a systematic
approach. A systematic approach is one that includes identifying a potential improvement, testing
the strategy for change, assessing data from the test to determine if the change produced improved
performance, and implementing the improvement strategy system-wide.

Management of the Environment of Care (overview)

The goal of the management of the environment of care function is to provide safe,
functional, aDd effective environment for patients, staff members, aDd other individuals in the
hospital which is critical to providing patient care aDd achieving good outcomes. Achieving this
goal depends on performing the following processes:

Planning by hospital leaders for the space, equipment, aDd resources needed to safely aDd
effectively suppon the services provided. Planning aDd designing is consistent with the
hospital's mission and vision.
Educating staff about the role of the environment in safely aDd effectively supponing
patient care.

s
 201

DcftIopioa ICIIIdarda 10 IIIIIIaUn: Itaff aDd IIOIpitaI perfonIIaDI:e in IM-Iioa aDd

ImpIcmei.hc pllDllOcreate aDd IDIIIIF die boIpiIal'l eDViroIImeDl of cue.
Reduce aDd COIIIrOI cnviroDmeDlal bIzuda aDd riIkI.
PreVCDlIII:CideID aDd riIb.
Mainrain safe COIIditioD8 for patieDl, visitors aDd sratf.

Tbc perfOlllllDCC-improvemenl framework is used 10 desip, JIIeIIUR, assess, aDd improve tile
orpnizaIion~s performIIII:e of die IDIJIIPIIICIIl of tile eoviroamcul of cue fuDctioa. Tbc
mana"........ process for design, implemed, moniror, assess, aDd ~ COIIIpOJIeDIS are Ipplied
10 tile SWIduds.

DESIGN
, C.I "Tbc 0IJInizati0D desips a safe, aa:essible, effective, aDd eftic:ieIIl cnviroameDt of cue
, CODSisIcnt with its mission aDd services, aDd law aDd regulation.
EC.I.3 A IIIIDqCDIaIl pIIn addrases safety.
ImemofEC J 3

To conduct risk II. . .nau tbat proacaMIy evaluate die iqIIct of buiIdiDp, pouDds,
equipment, occ:upuJts. aDd iDIemaI physical sysrems on )IIIieIIl aDd public safety.
EC.1.4 A mmagemeal plan 8ddreaes 1eCUrity.
Intr:nt oUC I 4
A security 1M.......... plan cIea::I'iJea bow die CR,MhilJli"ll will aIabIisb aDd maiIain a IeCIIrity
managemem program 10 proteCt sratf, )IIIieIIls II1II visiton from bInD. Tbc plan pnmdes
processes for
a. Leadership's desipalion ofpcnollllel rapoDIible for cIeveIopiug, impJemenrina aDd
monitoring tile security managemedplan;
b. AddIessing security issues c:oacemiDa patieIa, visitors, penoaueIlIIII property;
c. Reponing II1II inveadptiDg all security iDcideDs invo1viDg patieIa, visitors 1llll1taff;
d. ComroUioa aa:ess 10 ~ areas, as determiDed by die orp"izw'inD; II1II
f. Providiug vchicuIar aa:eas 10 urpDt cue areas
'In addition, tile plan esublisbes

6
 202

I. A security orieDWion and education program that Iddreues:

1. Processes for minimizing security risks for persounel in security-lICJISitive
areas,
2. Emergency procedures followed during security incidents, and
3. Processes for reponiDg security incideDts involving patients, visitors, personnel
and property;
h. Performance standards for
1. Staff security management knowledge and skill,
2. The level of staff participation in security management activities,
3. Monitoring and inspection activities,
4. Emergency and incident reporting procedures that specify when
and to whom reports are communicated, and
S. Inspection, preventative maintenance, and testing of security equipment
1. Emergency security procedures that address
1. Actions taken in the event of a security incideDl or failure
2. Handling of civil discurbances,
3. Handling of situations involving VIP's or the media, and
4. The provision of Idditional sWJ to control human and vehicle traffic in and
around the environment of care during disasters.
The objectives, scope, performance, and effectiveness of the security management plan are
evaluated 1IIDI8l1y.
Examples of Evidence of Performance for EC.1.4
Manalement plans for the issue(s) addressed in the standard
Performance standards for the issue(s) addressed in the standard
Emergency procedures for the issue(s) addressed in the standard
Staff inrerviews

IMPl.EMENT
Col The organization provides a safe, accessible, effective and efticieDt enviroDmem of care
consistent with its mission and services, and law and regulation.
EC.2.1 Staff members have been oriented and educated about the environment of care, and

7
 203

poaeII the bIowJedae ad IkillIIO perform Ibetr reIpOIIIibiIide UDder the euviromlll:ul of care
JDIIIIIeIDeiIl pIaDa.
Inb:nt of pc 2 J
Personnel can describe or demoDsttare
Personnel in security .seasitive areas of the environmeot of care can describe or
demoDstraIc
I. Processes for 'XIinjmizq security risks;
'XI. Emerpucy proc:edures for security ~; ad
n. Reporting proceduJes for security incidents involving patieDIs, visitorS,
penonncl, ad property.
EC.2.3 The organization implements the security management plan IIId performance standards,
includina all features described in EC.1.4
EumpIes of evidence:
Buildin& IIId grounds tour
Observation of visitor security procedures
Staff inlerviews

MEASIJRE OIITCOMES OF IMPI.EMEN'J'ATION

ECol An orpnizationwide Information Collection Evalultion SySIaD (ICES) is developed ad
used 10 eva1uate condiIions in the enviiomnent of care.
ECol.1 The organization appoiDIs an individual 10 diIec:t an onaoiDa orpnizationwide process
10 collect information about deficiencies IIId opportunities for improvemeul in environment of
care programs.
Imc:t!t of Fe 3 ]
b. Reviews SUIIIIDIJies of deficieucies, problems, failures, IIId user errors relate
10 INNBiDa
2. Security
EC. 3.2 The orpniDtion analyses idemified environmed of care safety management issues ad
develops or approves recommeodations for resolving them.

Management of Human Resources(overview)

A hospital needs an appropriate IIIIDber of quaJifJed people 10 fulfill iIs mission mI meet the
needs of the patients it serves. The goal of this fUnction is 10 identify IIId provide the right

8
 204

Plannina. The leaders' Plannina proc:ess cIefiDes tile qualifications, competeDCies, IDd
staffiDg ncc:essary to fulfill tile hospital's mission.
Provide competeDllllff. The leaders provide c:ompeteDt staff eitbcr tbrougb trlditional
employer~loyec arraJIICIDeDlS or COIIttIctIIaI arrIJIICIDCDlS with other eutities.
AssessiDg, JDljnlajniDg, IDd improviDg staff competence
00g0iDg , periodic c:ompefaJCe IS.............. eYIIuItes staff members' continuing Ibility to
perform tbrougbout their usociltion with tile bospital.
PromotiDg seJf-clevelopmeDt IDd IcImiDg

9
 205

..

L_ _ doflt.. _

. .Ilfteett_.

r
I
- '... 1_. . . .
aUfff", _
cerry _ _ .tat..
to

...... , _tntetn,
""-
- '.... of ataff

HR.1 The hospitalS leaders dcfiDe die qualificItioos IDd perfOl'lDlllCe cxpec:talioDs for 111 staff
positions.
Enmplcs of Evidence of Perfnnnana: - HR J
./ Departmcnl-specific: staftiDa plans ./ Hospital or dcpartmenta1 policies
./ Policy IDd proceclumi
./ Staff iDterviews ./ StaftiDa plans
./ Senior IDd dcpartmenta11cadership ./ Staff development plans
inrc:rviews ./ ID-sc:rvicc: IDd COIIliDuiDg c:ducaIion
./ PerfOllJUlllCC evaluations or records
compc:tc:DCy-assc:ssmc:nt mechanism ./ Oric:nwion curriculum
./ COntraclS ./ R.c:pons IDd meeting miD1tc:s
./ Employc:c: pc:rsoDIICI fiIc:s ./ Employc:c: broc:hurc:s or bandbooIc
./ Job dc:sC:riptions ./ Description of Iicensurc:.
c:ertifJCaleS. privileges. IDd
c:redc:ntiaI vc:rification process

10
 206

JlR.2 The hospital provides ID ldequau: IIIIIIlber of staff members whose, qua1ificad0llS are
cousistcm with job respoasibililies.
HR.3 The leaders eusure that the compe1eDCc of aU staff members is assessed, m,jnllimd,
dcmoastratcd, IUd improved CODtiDually.
(For persoDDd provided throuah a COIIIrlIdual ~, the hospical maintains a written job
description IUd a c:ompIeted compeceuce IS't'Ismeut, evaluation, or appnisal tool for eadJ
iDdividual).
BR.4 An orieDIation process provides initial job training IUd iDformation IUd assesses the staff's
ability to fulfill specific responsibilities.
Inu:nt of HR 4

The orieuration process assesses eadJ staff member's ability to fulfill specific
raponslbilities. The process familiarizes staffmcmbers with their job and with the work
enviromnent before the staff begins patient care or other activities.
BR.4.2 Ongoing in-service IUd otber education IUd .training maimain improve staff competency.
Imenr of HR 4 2
, The hospital ensures that eadJ sraff member participates in oogoing in-serve education IUd
otber training to increuc his or her knowledge of wort related issues.

11
 207

CONCI,11SION:
Many of tile security-related objectives remain in place from tile 1995 lCAHO staDdards,
There are however some minor changes aud additions that Deed to be adapted into tile 1996
JCAHO Security Management Program. Surveyors will CODtinue to spend a great deal of tlleir
time looking for dcmoDstrative perfOl'lJllDCe of knowledge, competency and actions from staff
members to validate tlleir ability to DJaIIIge tile enviroDmeDt of care, By UDllerstaDding tile
information CODtained in this security related overview of tile 1996 Compa:bc:nsivc Acc:m!ifarion
MaImal and complying with tile appropriate staDdards, a facility should be able to functionally
document and perform in a maDIIef to successfully complete a JCAHO survey.

12
 208

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 214

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 Ref..... s--z ---I Y. I No r= ~:
HR.3.2 Staff orienlalion process provides inkial job lralninc
and infonnalion. includi., an _ _ of an
individual', capabilhi.. 10 perfono apecified
respoDlibilkies. Orienlllion proew is desi,.... 10
promole !he IIfeleffeelive perfonnance of SIIff
memben' responaibilhieland familiarize !hem ...hb
!heIr responaibllhiel and/or work environment before
Inhiallni activhiel.
HR.3.3 ODJol.., .aervlce and/or oIher educadon and lrlininB
mailUin and Improve SIIff compeIeIICe by 0IIIIIrinB Chal
SIIff'-' pullcipale in oncoInI ilHervlce
_ion _ioOI and oIher work:re""" .....
HR.3.4 The orpnIzadonIcIeparIn.- coIIectI .............. on
an ...... _ repnl'" "'f~ ......rna
and _ 10 IdenIify and reapoad 10 iliff .........
....... DIll Is .....yzed for paaerna and _ 1 0
It) idenllfy off IearnIns ...... and offer _ _ II>-
.-4 service ~rrOinIn" 011:
~ HR.4 The orpnIzadonIcIeparIn.- _ an Indlviduala
,bilily 10 achieve job eapecllllona II lilted in bIs or ber
job deseriprion. Comperence _ _ acdvIIIeo
aboulcleaill and be _ for _lIIffmember.
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I
 217

VI. QUAUIY ~EMENT'

Security quality management deals with a quantifiable method of detennining the
effectiveness of the security program. Various institutions have different methodolo-
gies; most develop specific aspects of services with indicators identifying how
measurement is achieved. These indicators would usually be expected to fall within
certain 1:hresholds for evaluations.

In order to identify and analyze aspects of service, security managers should

follow this six-step process.

1) Identify areas of concern or problem of which the security department is held

accountable.
2) Analyze the concern or problem as it relates to the service delivery and
expectation of the security department.
3) Examine all potential alternatives to the concern or problem.
4) Select the best possible method to address the concern or problem.
5) Implement the chosen method of correction.
6) Monitor the action and improve as needed.

By following this format the security manager will be able to qualify and quantify
the actions of the security department. The aspects of care or service will state
what the manager is attempting to accomplish. A statement of an objective or
rationale will address why the aspect of service was developed. The indicators will
then outline the specifics of the evaluation. The 1:hresholds for evaluation will set
the acceptable parameters in which action should be accomplished. These should
be established as realistic yet achievable goals. The methodology will establish how
the evaluation is determined. In the event thresholds are not met, the security
manager can investigate, identify, document and take corrective actions to assure
future compliance. Finally, the data source will address the documents or sources
of the information.

58
 218

Figure #14 on page 60 is a sample format used as part of the quality

management program for security services at Baptist Medical Center in Jacksonville.
Florida.

The format descnbed in Figure #14 was used by all departments to identify areas
of concern. These reports were given to and addressed by the Medical Center
Quality Assurance Committee. Each major department was required to submit
report on a quanerly basis. A consolidated report was then constructed and shared
with administration.

Quality management should be use to track and monitor on-going activities

within the securltydepartment. This will allow the manager and administration to
determine the effectiveness of the department as well as pertinent trends. These
trends can then be used, through the evaluation process, to take corrective actions
and strengthen the security program. For example. when security personnel are
regularly unable to respond to stat/emergency calls within the appropriate time and
within the thresholds for evaluation, this might suggest to management that
procedures need to be improved. that additional personnel may be required, or other
corrective action is needed.

Graphs and charts can also be an effective way of visually measuring the changes
in activity levels. These changes may act as indications that certain areas need
specific corrective actions. See Figure #1S on page 61 and Figure #16 on page 62.

In the 1992 Accreditation Manual for Hospitals quality contjnues to be stressed

starting with a name c:1umge in the chapter formerly known as Quality Assurance
to Quality Assessment and Improvement.

S9
 219

FIGURE #14

MONITORING AND EVALUATION

SUMMARY

Dl!PAR'IMI!NT: Safety, Security, " Parking

DA'l1!: August
September
October

ASPI!CJ' Of CARE/liI!IlVlC!
The Safety, Security aDd Parking Depertmenr wID provide a 2minute response to various
~ situaDoas.

0iIJI!CJ1VE OIl RAnONALE:

To insure prompt response to emergency situations.

INDICATOR(S):
11ambg1d. fpr Eyaluation

1. Fire Response 95%

2. IntnWosVRobbery Alarms IIespoDses 95%
3. SfAT/EmeraebOY Rapoases 95%
4. Patient Restnllnts AaistaD<e Rapcmses 95%

MP:IHODOLOGY (TIME PRAME, SAMPLE SIZE, SfAFP, HOW?):

Because of the _ ~ reponins system, 100% of the iDcident reports uwIlire
reports are being reviewed on montbIy basis by the Security Supervisor.

DATA SOlJR(E:
1. DaiJy Activity Reports
2. Incident Reports

60
 220

FIGURE #15

ca.......r 1'.7 1918 ., . . .

1989 1990 1991
Al&n1/Pal..-Plre
Alu./".l -Iecurlty
Me.1llt
l
16
0
U

0
ll'
116,
0,
.,'"
..
9
1
6
, "'"
-7.,
10
U
o
6"

-lOOt
1.
I

0
-50.
38\
0,

Aut.o Acclc1ent. 0 1 .,'" 1 o. o -100\ 0 o.

Break. I: anter . -hl1d1ng:
areak. I: antR.-Vehlcle
0
1
0
o -100.
0, 0

0
0,

o.
1
0
.,'"
Ol 0
1 0'
o.
Dlaturbance-Vlalt:or 0 2 .,'" 1 -10l 2 100' o -100.
n .. 0 0 0, 2 .,'"o. 1 -SOt o -100.
round _ r t y

Info~tlon.
0 0 o. 0 3 .,'" 1 -6"
Only 16 21 3n 17 -19\ 1.
" U 128'
Ml 1 . . Property-Facllity 1 o -100' 1 .,'" l 200,
33\
Ki int Property-Perecna&l
.atieat AaaJ.atance-IIOIl D
1
6
1
1
o.
-83\
o
2
-100\

100'
0
l6 1700,
0, 2
28
.,'"
-2n
.... IDc1dent:~.ceae call 0 0 o. 1 .,'" o -100, 0 0,
luap. Per.an-coataeted 1 o -100, 2 .,'" I lSD, 2 -60'
Suap. "rllOn.-1IO CDfttact 0 1 .,'" o -100. I
.,'"
.,., 1 -80\

.,.,o.
'l'hreat-ac.b 1 o -100. 0 1 o -100\
Vand..li.~ .cl11ty 1 o -100. 1
300. 5 2$\

Note:
-
VandalJ. __veblcl. 1
.8
0-100.
72 So. ..
0 o.
-39\

"N,A" appear. when a . .thaatical calculation ia invalid

1
10l
.,'"
13.,
o -100.
108 $\

(caud When di vidill9 by zero).

SOURCE: Hospital Shared Service. of Colorado

61
 221

FIGVRE#16

Bach Incident/Fire category _y PrOperty Inoidenta

not cantein enough activity to Auto Accident
accurately analyze the frequency or Br.aking , Entering-Building
.ariOUllJlella of evente at Saint Breaking , Entering-Vehicle
Barnabaa Jllldical center. COIIbining Kia.ing Proparty-Facility
aiailer categori. . , -y expo Ki ing Proparty-Peraonal
patterns that _ld otherwia. be Hiaaing Proparty-Vehicle
lIJIrecogniaable. Each Incident/Fire Vandali..-Facility
category vas COIIbined aa foll.,.,.: Vandali..-Peraonal
Vandali..-Vehicle
8erYi_ :Eacli_te
Alara/Fal-Security Paraonal Inoidenta
Found Prc>party Asaault
Infor.ation only Diaturbsnca-z-ploy
Patient Asaiat-ER Disturbanca-Visitor
Patient Asaiat-Non BR Drug Abuae
sexual Incident-obscene Call Robbsry-ArIlad
SUSpicious Para_contacted Robbery-unar.ad
suapicious Person-No COntact Saxual Incidant-Assault
Tbr..t-Boab sexual Incident-other
Tbraat-Otbar
aevalatol<]' IlIOilleDte
Alara/Fal..-Fire A qrapb of .ach s\llllllU"ized
Fire Incident/Fir. category is displayed
below:

Historical View of Sectrity Incidents

"
100

80
.,/"
-
5InIco b:IdInIs
-e-

-
~ 80
~ / "'-'Y-

.
: 70
80
:A /
.......
Roa&*Ifory -

I
'0
50
40
/
/ \
\
V
/
/ ...--
30

J 20

... -'"

---
10
-----::.--
0
1987 1988 1989 1990 1991

SOURCE: IIoIpiral Sbued _ of Colorado

62
 222

Some hifhlights of continuous quality imProys:jnent. The Joint

Commission's transition to continuous quality improvement standards
will draw upon the insights of the originators and major developers
of continuous quality improvement, such as W. Edwards Deming,
Joseph Juran, and Philip Crosby. Principles of continuous quality
improvement incorporate the strengths of quality assurance as it is
CUITendy practiced, while broadening its scope, refining its approach
to assessing and improving care, and dispensing with the negative
connotations sometimes associated with it. In moving toward
continuous quality improvement, the Joint Commission wants
healthcare organizations to build on the strengths of their present
quality assurance mechanisms. These mechanisms and the pers~

who have established them constitute a substantial foundation from

which to launch the transition to continuous quality improvement. 1'

With this focus and emphasis from JCAHO all areas of health care, including
security, can expect to become more involved in total quality management (TQM)
or continuous quality improvement (eQI) efforts from their organization. More and
more activities will become part of a "process" thus requiring greater intervention
with other components of the organization and better team efforts.

63
 223

W. nIB Pl1IURB OF HEALnICARE SEaJRrrY MANAGEMENT

Many security IIIIIDIIgers are striving to fortify and develop their expertise
specifically in security. Although this is very important, many security directors are
losing their jobs or their jobS are being eliminated or down graded.

The reason for this in most cases is simply finandal. Many bealthcare
facilities in America are in a state of fiscal crisis. As money becomes tighter,
administrators and chief financial officers are determining where dollars can be
saved. These cuts are DOt taldng place in the areas of nursing or premium positions
where salaries and benefits continue to grow. As a maner of fact these salaries are
- at.aIl time bighs. Benefit and perk packages are very competitive among bealthcare
providers for these positions.

What does this mean for persons involved in the healthcare security field?
Our job is to work harder, think smatter, and be business minded. In other words,
seardl your budget and look for areas to make your operations as efficient as
possible. The old days of spend it or lose it before the end of the next year's budget
are long gone. The astute healthcare security manager will trim his or her
operation before someone trims it for them. This is especially important since in
some cases the trimming has been the director or manager's position.

In one case in Florida a hospital hired an independent management

consulting firm to reduce the overall hospital expenditures by 10 percent. When the
consulting group reviewed the security department which had an annualized budget
of approximately $500,000, the security director was well qualified and had a great
deal of experience and bad an annual sabuy of approximately $50,000 per year.
Since there was an assistant director and a minimum amount of working security
personnel (in the consultant's opinion), the director's .POSition was eliminated aad
the assistant director's tide was changed to manager. The end result: a 10 percent
savings and one more security director on the street.

64
 224

Each security director -must be aware of the economic climate within their
facility. In general the national trend including healthcare is to reduce middle
managers. Even if the institutional budget appears sound, don't become known as
a big spender. Become known as a businessminded, cost-effective manager.
Explore various alternatives to make all of the operations you manage as cost-
effective as possible. Examine every area and function as if you are operating from
a zero-based budget system. Be prepared at any time to justify each and every
financial request and budgetary line item.

As defined in Managerial Accounting, Second Edition by Calvin Engler, ~ero

based budgeting is a method of budgeting that starts with a base of zero and rBnks
each program and its cost, starting with the one most vital to the organization. In
a manner, managers can choose to fund programs on the basis of merit, without
preconceived notions about what must be included.'olII

Give things up in advance and if you don't need it, don't ask for it. At the
same time be sure to take credit for this philosophy. Let the appropriate people
know that you are attempting to improve your efficiency and cost effectiveness to
the organization. Usually you don't have to look far to see which of your fellow
directors or managers are moving ahead and obtaining greater responsIbilities. They
are usually the ones that are already cost effective and efficient.

Being creative is essential. Look at your staffing which is your greatest line
item. Through attrition, can you hire part-time staff instead of full-time? This not
only saves benefit costs to the institution but also should defray ~e since you
have a manpower reserve to call upon that are normally scheduled at less than 40
hours per week. Have some of employees been with the organization too long?
Certain jobs are worth only so much per hour and some security employees actually
make too much for what they do. Can the institution afford to pay for this? Can
these people move to other departments within the organization? Remember
turnover can be good or bad depending on how you manage it. Are there any other
staffing options that may be viable? These are questions that the astute business-
minded security manager should ask and answer before an administrator does.
6S
 225

Healthcare security managers need to continue their professional

development in the field of Security. However, in addition to this, it is of the
utmost importance that they explore a business-minded approach to management.
Cost effectiveness aDd efficiency are key items on which they will be judged by their
superiors. Administrators are usually insistent that management personnel explore
all potential alternatives and have a sound rational behind their recommendations
and methods of operations. Survival means being creative in advance of being told
what and how you will trim your organization.

This proactive approach should help you not only survive the budget
tightening process that is expected to continue in the healthcare arena, but also
excel by proving your effectiveness and wonh to the organization. This in turn
might result in added responsibilities where you can continue to demonstrate your
management abilities.

MANAGEMENT IN mE NINETIES
As healthcare continues to become more sophisticated, each.department must
keep pace, including security. The education and integration of the various
departments and employees of the hospitals with regard to security issues will
become even more essential.

The administration of a hospital security department will require professional

managers to develop and maintain successful budgets with limited resources. The
use of electronic security devices in conjunction with manpower will need to be
regularly and carefully reviewed to provide an adequate overal\ security program.

As the litigation trend-continues, security incidents that occur at hospitals

will be closely examined. The competency of security managers and officers will be
reviewed by expertwitnesses. The education, experience, training, and certifications
of both will come under close sautiny.

66
 226

Hospital security has been elevated to a more significant role in our nation's
health care deliYel}' system over the past ten years. 'Ibis role has been stimulated
by greater violence in hospitals, increased awareness of the extent of property losses
and the litigation epidemic alleging inadequate hospital security. Far too many
cases have resulted in multimillion dollar awards or settlements.

The security role should be viewed in two separate and distinct categories.
First, personal safety: approximately 90 percent of the security effort is directed to
the protection of staff, patients, and visitors. Second, property losses: hospital
property losses alone, are estimated to run in the area of $2,000 to $3,000 per bed
per year.

Although security is generally referred to in terms of physical safeguards, it

must be understood that security is also a perception. Even when there is a lack of
serious incidents, or few obvious vulnerability, if the staff, patient or visitor feels
apprehensive or uncomfortable, the security program must react to the perception
and implement plans to create a positive image.

Figure #17 on page 68 describes trends (derived from professional literature,

national and regional seminars, and Hospital Shared Services consulting projects)
that forecast of events for the future of healthcare security through 2000.

In the December 1991 issue of ~ Figure #18 on page 69 contains a

chart which projects a comparison between yesterday, today, and tomorrow in how
security in general is evolving.

Because hea1thcare is an advanced field, [ believe that many of the various

components outlined in this chart will come to fruition in the healthcare security
field as well.

67
 22'1

FIGURE #17

HEALTIlCARE SECURITY 'fREl:IDS - 20001

IDcreued trainius for .n leveIJ of hoIpltalleCllrity penonnei.

lnaeaing ~tofhoipltal employees, iDcludIngllOlHeCUrity IuperYiso!ypenounei,
In contributing to die maiDtmance of we UId IIIft premiIes.

Epldemk leveIJ of lItipIion conceruIng security prosrams.

More RCUrity penonnel worIdna In an mwmed capacity.

A abIft from security by prvriding non-security related RrYic:es to a &rUler emphasis on the
basis of "pro-acdw protection acttrida.

A trend towvcl separating RCUrity and wety management U the wety function becomes
better defined. Security personnel to continue as being ancillary to the wety function.

A decrease In the owr.n use of centralized closed cin:ult television and a abIft to
departmental systems.

IDcreued use of alums, computaized card access controls UId Integrated securily systems.

A greater _ _ _ by die hospital administrative mtl of die need for more loss prevoention
safeguards to enhance the bottom line.

Violence in emergency rooms remaining at die hIP 1eftl experienced during die past
-uyean.

lDcrusiJIgRCUrity buclgetI despite attelDpb to supplementsecurilyJlWlllCl'ftl"witb phl'ica1

securily systems.

Greater orpnizaUona1 demands on security as law enforcement MrVices continue to

climiDish.

A greater number of facilities util~g contract or alternative security services to reduce

com. .

A continued trend to coll101iclate management positions including die restrUCtUring of

RCUrity cIepanmenu to be managed by odler areas within die organization.

A greater need to conduct securityrisk _ e n t s to identify and provide countermeasures

to potential aclftne incidents.

A greater Involvement by RCUrity personnel to provide geriatric and Alzheimer'. patients

with specific security protection as that group increases In number.

68
 228

FIGURE #18

THE SECURITY EVOLUTION

Yesta'day Today TODIOIIUW

PuDctiml Security Asset
Protection . Resoun:e
Management

CoaI:ept Stand-alone
Interfacing
lntegration

SbdfiDg Propriewy
Hybrid -
Proprietuy
and Contract
In-house
Consultant;

Facilities
Management
Services

TecbaoIogy Medumicals;
Electronics;
Digital;

Analog;
Medumicals;
Networks;

Electronics
Networks;
Software;

Digital
Electronics;

Medumicals

Source: Seg!riry Massi!le December 1991.

69
 229

A specific ~bility of the security maDagei- needs to be a , regular and

documented risk assessment of their facility. It , will become more popular for
institutions to utilize outside consultants to give an objective view of the security
risks and make ftCODImendations to be c:cmsidered by the security DIlIDIlger and
hospital admiDisttation. Litigation will increasingly be a problem because of
reductions of security personnel, improper or inadequate training, lack of
documentation, DOt addn!ssiDg foreseeable c:rimes/mcidentseither on the hospital
premises or surrounding area, not attaining local or national standards for security
services,lack of or malfunctioning security equipment, lack of security policies, and
lack of administrative support for the security program.

In the years ahead, a continued emphasis will be placed upon security

managers and departments to provide a high profile and enhanced public relationS
image for the facility. Unifonned security personnel are administrative agents of the
hospital as pen:eived by the public. It will be necessary for the administration of
a hospital and the various departments to realize and accept this elevated role
within the organization.

Liaison with law enfon:ement agencies will become critical. As demonstrated

earlier in a refaence from the Hallaat Report n, as the number of law enforcement
personnel become fewer per capita, security organizations will take on a greater
responsibility in providing protective services within their respective organizations.

Increased security emphasis will be placed on highrisk areas in healthcare

facilities such as anageocy rooms, nurseries, psychiatric units, drug and alcohol
units, and pharmacies. This will require the security personnel to have a greater
understanding of bow to cIeal with people under stress or displaying aggressive and
assaultive behavior.

70
 230

A continued and greater emphaSis will be placed on crime prevention efforts.

1bis includes crime prevention materials, handouts, flyers, and posters. Security
fairs will become more popular and allow the security staff to interface with other
hospital personnel to gain understanding and support for the security program.

Quality management will continue to be a driving force in assuring that

proper documentation is maintained which facilitates trend analysis and corrective
action in problem areas. Along the same line, risk management will assure that the
forecasting of incidents is maintained to avoid unnecessary losses.

With the continued financial strain in healthcare, loss prevention will

continue to become even a more important issue in the 1990s. Security, safety, risk
management, and quality assurance must strive together to identify, prevent and
deal with incidents that might result in financial loss, either through frequency or
severity of the situation. at the least possible cost to the institution.

71
 231

A!;,PENDIX
SECURI1Y ASSESSMENT

General Instructions

I) Multklisc:ipliDary groups or people can be helpful in conducting a security risk

assessment of a facility and partic:uIarIy in individual dcpartmcnts.
a) Whcn possible solicit thc assistance of thc safcty officer, risk managcr, and thc
department bead of each specific area reviewed.
b) In each area, c:bcck generic security-related matters such as functional locks,
lighting, unsecured items, ctc.
c) Look for unit specific wlnerabilitics (i.e., unsecured narcotics in lCU).

2) Consider concepts such as rings of protection (outcr and inncr areas sucb as outsidc
protection, perimeter doors and individual units), operational \IS. non-operational timc
frames,ctc.

3) Review thc various sources identifying possiblc risk assessmcnt vulncrabilities.

Past Security Incident Reports, Investigative Follow-up Rcports.
Po6ce Reports - statistics.
Organization fccdbacklpcrceptions/concerns.
Industry standards.
LocaJINational bcalthc:arc security standards.

4) Assigning risk threat IeYCIs (3=bigb, I-low, and O-=N/A)

a) High, cither through frequency or severity, of thc likelihood of a specific
incident occurring at that location. Hip rating MUST bave action plans.
b) Medium, would indicate thc posSIbility of a specific incidcnt occurring at thc
location. -Medjum rating SHOUlD 11m action pJans.
c) Low, would indicate that a specific incidcnt would most likcly not occur at that
location. Low rating MAY have action plans.
d) Not applicable, self explanatory.

72
 232

S) Annual Security Risk Identification/Analysis Form

a) Date the review was conducted.
b) Reviewer, person in charge.
c) List the various departments or areas reviewed in left hand column. (see
sample form)
d) List the risks reviewed across the top using attached list. (see sample form)
e) Rate each department/area with the appropriate risk threat level (high,
medium, low, not applicable).

6) Security Risk Action Plan

a) Date the review was conducted.
b) Reviewer, person in charge.
c) List the various departments or areas reviewed in left hand column.
d) Briefly explain the action plan used to abate the potential risks identified from
the Risk Identification/Analysis Form. Use specific time tables.

7) Security Abatement/Monitoring Review

a) Date the review was conducted.
b) Reviewer, person in charge.
c) Ust the various departments or areas reviewed in left hand column.
d) Three to six months after the initial review, a follow-up is essential.
Document the results to date and make changes when and if necessary.

8) Annually (unless specific changes warrant more frequent reviews) conduct another
survey/assessment.

73
 233

ASSAULT IMPOSTORS
SIMPLE
AGGRAVATED KICKBACKS/FRAUD

BOMB THREATS/BOMBING KIDNAPPINGS

BlJRGIARY LOSS OF INFORMATION

CIVl:L DISTURBANCES ROBBERY

DIS'l'URBANCBS ARMED
uNARMED
IIITBRNAL
STRIKES
EXTERNAL
DRUG ABUSE TERRORISM

GANG ACTIVITY THEF'l'

VISITOR/CUSTOMERS
GAMBLING STAFF PROPERTY
FACILITY PROPERTY
HOMICIDES
OTBBR - SPECIFY
(JIAltB THESE APPLICABLE
TO HBALTHCARB FACILITY)

SECURITY RISJ{ ASSESSMENT SOUR<D

POLICE STATISTXCS ( _ l l _ t area breakdown available)

PAST SECURITY XNCIDBNT REPORTS

ORGANXZATION FBEDBACK/PERCBPTXONS

CASE LAW

INDUSTRY STANDARD PRACTICES

INSPBCTXON

LOCAL/NATIONAL STANDARDS

CONSULTATION

74
 y"-' ... .... ."
Dat.

. . ."
I!" . ........ .. .. ....
I

.. p
U L
N
a OK
a HR
o V
I.
0
R
0
" c " p
80
H
P P P.
"0
...
D8PAltTllaft
ARD
S
.. D " Y Y

GUUAL CAMPO.
LOADIIC DOCK

aosInss OFl'ICS
LOCDR ROOK (Mb,
LOCDR IlOOII ( _ ,

PQKIJIQ DKCIt

TIIRl!AT LEVEL KEY

H-Hiqh (3); "-M.diu. (2); L-Low (1); K/A-Kot Applicable
Reviewed By: _________________________________ Completed Dat~: __~__~__
Reviewers: _____________________________________________________________

7S
 235

Security Risk Action Plan

-.,1t&1 _ _ _ _ _ _ _ _ _ _ __
Date _ _ _ _ _ _ _ _ _ _.,,-
""1_ _ _ _ _ _ _ _ _ _ __

Attach additional dOClmentation a. -..s.

76
 236

Security Abatement I Monitoring Review

_pital _ _ _ _ _ _ _ _ _ _ _ _ __
Date _ _ _ _ _ _ _ _ _ _ __

.....i _ r _ _ _ _ _ _ _ _ _ _ __

Attach additional documentation as needed.

77
 237

Richard S. Post and Arthur A. KingsbUly, ScgJrity Admjpj:nratjpnj An

Iptroduction, Third Edition (Springfield, IL: Charles C. Thomas Publisber, 1977), p. 6.

:a George L Head and Steven Hom 0, EsKpri.1s of the Risk MBpgmmt Process,
Vol. I (Malvern, PA: IDsuranc:e Institute of America, 1985), p. 6.

Fredrick G. Roll, "Safety and Security - Risk~, Jourpal of

Healtbc:arc Protection MJmamncnt, Vol. 5, No.1 (pall 1988) pp. 87-90.

4 Russell L Colling, Hospital Security, Third Edition (Stoneham, MA: Butterworth-

Heinemann, 1992) pp: 58-60.

S Fredrick G. Roll, "Walk SoftlylCaay a BiJ Sticls". Webster University, Security

Management, Security Management #506, Man:h 1992.

6 William C. Ctmningbam,et aL, The Hallcrest Report U: Priyate Secyrity Trends

C1970 to 2000> (Stoneham, MA: Butterworth-Heinemann, 1990), p. 176.
7 Charles P. Nemeth, Private Security and The Law (Cincinnati, OH: Anderson
Publishing, 1990), p. 78.

William C. Cunningham, et aL The Hallqest Report IT: Private Security Trepds

0970 to 200Q) (Stoneham, MA: Butterworth-Heinemann, 1990), Table 7.1, p. 229.

, James Arlin Cooper, ComPuter and CommunicatiODS Security (New York, NY:
McGraw-Hill Book Company, 1989), p. 183.

10 Charles A. Sennewald, Effective Security ManaRmmt. Second Edition

(Stoneham, MA: Butterworth Publishers, 1985), pp. 196-197.

II Richard S. Post and Arthur A. KingsbUly, Security Admipjstration: An

Introduction to the Protectiye Services, Fourth Edition (Stoneham, MA: Butterworth-
Heinemann, 1991), p. 103. '

U R. Keegan Federal, Jr. ed., AyoidinJ Uability in Pmnjses Sec:wity (Atlanta, GA:
Strafford Publications, Inc., 1989, PublicatiODS, Inc., 1989), p. 159.

I. Acgt:djtation Manual fur Hospitals (Oakbrook Terrace, IL: Joint Commission on

Accreditation of Hea1thcare OrpnizatiODS, 1992), Vol. I, p. xiii.

78
 238

14 Assmtitation Manual Cpr HoispigJs (OakbIook Terrace, n.: Joint Commission for
&creditation of Hospitals, 1982), pp. 45--46.

15 Accreditation Manual fm Hospitals (Oakbrook Terrace, IL: Joint Commission fm

&creditation of Hospitals, 1986), p. 48.

16 ~o Security, Standards in JCAHO's 1989 Accreditation Manual," lk!miIIl

Security and Safety Managmept. Vol. 9, No.5, (Pwt Washington, NY: Rusting
Publications, September, 1988), pp. 12.

17 Acqedjtation.Manual Cpr Hgspitals (Oakbrook Terrace, n.: Joint Commissicm on

Accreditation of HealthcareOrgimizations, 1992), Vol n, Scoring Guidelines, Plant
Technology and Safety Management Section, p. 3.

Ie V. JIDle5 McLarney, "JCAHO Revises Safety, Security, PQwer Standards," ~

Facilities Management (August 1992), pp. 44-56.

19 Accreditation Manual fm Hospitals(Oakbrook Terrace, n.: Joint Commission on

Accreditation of Hea1thcare Organizations, 1992), Vol. I, p. xiii.

:10 Calvin Engler, Manamial Accounting. Second Edition (Richard D. Irwin. Inc.,
1990), p. 356.

79
 239

Statement of Richard P. Miller, 'Director, G.V. "Sonny" Montgomery

Veterans Affairs Medical Center, Veterans Health Administration.
Department of Veterans Affairs

Q. v. (.oma,y) IIoDtga.ezy VA Ne4icoal Centez-. oJacok.on.

1Ii i ippi.

Mr . Richard P. Miller became Director of the G.V.

'( Sonny) Montgomery VA Medical Center in August 1994. As
part of initial briefings. the Associate Director. Mr .
Richard J. Batlz, explained a carefully laid-out plan to
upgrade facility security personnel. policies . procedures.
surveillance equipment. and training for both police
officers and all employees. Mr. Miller endorsed the plan
and the following security issues were concentrated on:
z.proviDg th. quality of the police foz-ce. Like all
personnel issues. this is a continuing effort. but one that
has already shown results. Inspections of the police
service in February and March, 1997. by specialists from VA
Headquarters resulted in high praise for the qualifications.
training. appearance. and conduct of the facility's
officers. Officers at the Jackson VAMC have an average of
16.4 years experience. many with the City of Jackson Police
Department, and others with military units, the Bureau of
Indian Affairs, and other city and county police
departments. No one will mistake the facility'S certified
police officers for mere guards.
8Uz-veilaaee equipment. A color video camera monitoring
system was installed and has been continually upgraded over
the few years at a total cost of about $110.000.
S.curity acoc 8yet... Installation of computer
controlled door locks. identification badges. card readers.
parking lot controls and limited door access systems were
installed at a cost of about $95,000. This system provides
the ability to allow certain individuals access to specific
areas or entrances and to keep a log of their entry and
exit.
CaniDa pz-ogr... In 1995. the facility acquired a
canine trained in drug detection and missing patient
tracking. Though the dog is not an attack dog. it is a
cornmon belief that his presence would reduce any drug
activity, assist in locating patients who might become lost,
and have an overall calming effect on volatile situations.
Although the canine has not yet had to be used to search for
lost patients. there is confidence that his presence has a
chilling effect on drug activity and the police officers
report that his presence does indeed calm argumentative
individuals.
 240

Waa4eriag a1ert .,...t_ for D1lr.iag ~ pati_t.. To

protect nursing home residents. the VAMC invested in an
electronic system that alerts staff if residents who have
diminished capacity wander through an exit door. This was
installed at a cost of about $100,000.
Bike pat~1. To provide faster and more frequent
patrols of the parking areas at the Jackson VAMC, a bike
patrol was implemented at minimal cost.
The above-stated projects were underway in varying
stages of completion before the first of two tragedies
struck the Jackson VAMC.
Attaok OD aD .-p1oyee.

On January 30, 1995, at about B a.m., a 65 year old

service-connected, disabled veteran who had received care at
the hospital for a period of 30 years, attacked an employee
-- a VA physician -- in the parking lot near the outpatient
entrance to the hospital. He threw sulfuric acid on her
face, neck and chest, then departed the area.
Today, this employee remains unable to work, facing
additional plastic surgery, and carrying psychological scars
that are even more difficult to heal.
In February 1996, the veteran pled guilty in state
court and received a 20-year sentence. He died in prison a
few months later.
Based on a review of the veteran's VA medical record
(which spanned 40 years) and the results of police
investigation, the attack apparently was motivated by the
physician's refusal to prescribe inappropriate pain-killing
drugs that the veteran sought for illegal uses.
In the wake of that attack, police investigations,
criminal prosecutors, management, and an ad hoc
investigating committee identified concerns that resulted in
the following actions:
Elevated the status and scope of the multi-disciplinary
Committee for Disruptive and/or Suicidal Behavior. The
committee developed policies and procedures (implemented in
1994) by which (1) patients posing a potential threat of
disruptive or violent behavior are identified, (2) these
patients' names are -flagged" in their computerized records,
alerting clerks and clinicians when they have appointments,
(3) police routinely respond when such patients are
scheduled for an appointment, (4) denial of medication to
drug-seeking patients is referred to a committee of doctors
instead of a single physician, thereby diluting antagonism,
 241

and (5) a pain management cl i n i c was establlshed to help

pat i ents lean to cope with chronic, non-responsive pain .
One full-time employee equivalent (FTEE) was added to
police service to enable extra patrolling during normal
bus i ness hours .
All of the committee recommendations within authority
of management were enacted. A recommendation that senior
T\\anAC'!F.mPJJr_ PXQ.'lA'U'_ r-.hp_ i'lr.minq, a.f. VA. QO.lic.e. aDd . the use of
metal detectors was examined , but found to be not within the
authority of facility management and not likely to have any
relevance to an attack such as had occurred.
As an interesting aside to this case, we learned that
Federal jurisdict i on was not attained when the land was
passed from the state to the Fe deral government in the
1950s; t herefore, the FBI and U. S . Attorney ' s office had to
relinquish the case to local and state authority . We worked
closely with state leaders. the state legislature, and VA
Headquarters officials in obtaining s t ate legislation
granting concurrent jurisdiction to both entities. Today.
prosecutors can purse e i ther Federal or state prosecution of
crimes committed on the medical center grounds.
The attack on a VA physician was a call to concern , and
many changes were made as a result of that concern . But. we
fel t. and still feel . that the attack was an aberration. not
an indication of the nature o f the people of Jackson or the
St ate of Mississ i ppi . It was an isolated incident that
could not have been prevented by metal detectors or even
armed police (unless a police officer was escorting the
employee) since it occurred in a parking lot . .
In the wake of the attack, the VAMC implemented
especially responsive actions as noted above and continued
with planned security system improvements.
Murder aDd Suicide
Mr . Victor Bowles . a 48 year old service-connected,
disabled veteran. entered the hospital about 11:20 a . m . .
shotgun at the ready position . and within 30 to 40 seconds
found Or. Ralph Carter with a patient . He killed Dr .
Carter . then committed suicide .
In addition to the tragic consequences for the families
involved. the staff and patients of the VAMC, veterans
throughout the state. and the ci t izens of the City of
Jackson in general were shaken .
Investigations by local police and the FBI do not
reveal a clue. A psychological autopsy of Mr. Bowles'
medical records gives no clue. There are no answers .
 A review ot the security measures and police service by
VA Headquarters experts and other police agencies reveal no
flaws and speculated that the incident probably could not
have been prevented by any ot the measures now being
adopting. Indeed, it is believed that this tragic incident
is another statistical aberration in no way reflective of
the general mood of veteran patient, the veterans of the
State, or the other good people of Mississippi.
Since the murder/suicide, the facility has:

immediately contracted for seven security guards to

supplement the 12-officer police force and went to
extensive overtime for the Jackson VAMC police,

authorized six additional certified police officers and

have, to date, hired five,

sought and were granted inclusion in the test program

which is evaluating the effect of arming VA police
officers,

arranged for the installation of metal detectors and x-

ray devices at hospital entrances (to be installed when
officers are armed, since it would be imprudent to
attempt to confiscate contraband with unarmed officers),

limited public entrances to the hospital and will further

limit entrances to only two points within the next few
weeks as metal detectors are brought online, and will
require visitors to sign in.

fenced the loading dock and other support entrances and

placed a guard on duty there to control egress and
ingress during normal business hours,

accelerated plans to relocate the surveillance camera

monitor room to the emergency/ambulance entrance where
the officer can view the entrance through a large window
and control the door electronically (not only will this
increase. the officer's vision, but it will also increase
police visibility to visitors),

continued upgrading the camera system, with more units

scheduled for installation and improved recording to
allow cameras to tape for 24 hours, and

conducted outreach programs with veterans service

organizations to identify any existing veteran concerns
 243

and to enlist their support in dealing with complaints

and loose talk of threats and disruptive behavior.
The costs associated with these steps are significant.
Modifications to door locks. the installation of metal
detectors. and other hardware changes and additions will
have a one-time cost of about $175.000 with some nominal
recurring costs in maintenance and updating. Six additional
police officers will add another $300.000 annually recurring
cost.
The weapons will add an additional $16.000 in initial
costs and a nominal amount of recurring costs associated
with training. storage. and maintenance.
previously. the managers of the Jackson VAMC managed
their budget carefully. funding security improvements from
normal appropriations. but the massive effort undertaken
this spring caused the Director to seek supplemental funding
from the VISN so that the patient care mission could be
continued without impact by security concerns. The VISN
granted the funds.
 244

POS'l'-UUDIQ QUU'l'J:OII8
COIICDIIDIQ 'lim IlAY 22, 1"7
UUDIQ 011 ~ AlII) SKC1IRJ:'l'Y J:. '1'l1lI
Dm>U_ rw W'l'DUB An'ADIS

. . - '1'l1lI BOJIOII&BLIi LallI: IIVlUIS

RAIIKDIQ ~'l'J:C . . . . . .
COIIIIIJ:'l"l'D: 011 V1I'l'DAJIS' An'ADIS
U S. BOOS. rw RBPIIBIIBB'l'A'l'J:V1IB

Que.tion 1: What is the purpose of arming VA police officers?

What empirical evidence can you provide the Subcommittee that
armdng VA police officers will make VA facilities safe? What
will be required to achieve safety at VA facilities?
aa.w.rz At this time, no general decision has been made to arm
VA police. Rather, VA is conducting a pilot project to determine
the feasibility of armdng VA police officers. The reason VA is
considering arming VA police, is to test the appropriateness of
providing its officers with a tool that is consistent with their
duties and responsibilities and may allow them to better protect
themselves and others. VA officers are responsible for providing
protection and enforcing the law. one of the tools used by most
major law enforcement organizations in the United States (to
include the Capitol Police) is a firearm. We believe that the VA
Police department is the only major law enforcement organization
that does not provide its officers with firearms. VA officers
have performed admirably given their circumstances, however, a
number of them have paid the ultimate sacrifice. With the
addition of firearms, we believe that VA officers would provide a
more appropriate intervention. Based upon personal discussions
with VA officers and reviews conducted by Office of Security and
Law Enforcement staff, it has been concluded that VA officers can
function much better if they engage in more inquisitive patrol
activity. VA officers are required to conduct investigative
stops of suspicious persons as an iD'i>ortant part of crime
prevention. It is evident that they are not doing enough of
this, and also evident that the major reason is an understandable
concern that these suspicious individuals may be carrying a
concealed weapon. For instance, in the recent incident in Lake
City, Florida, a VA police officer made an investigative stop
shortly after midnight in the parking lot and was shot with a
handgun. The intruder, because he was armed and VA police
officers were not, then gained access to the facility, shot up
the waiting area, and directly threatened a wheel chair-bound
veteran with the firearm. The shooter was later taken into
custody by armed officers fram the Lake City Police Department.
An important part of the evaluation of the pilot program is to
determdne whether officers are being more vigilant in
accomplishing investigative stops. In fact, initial reviews have
disc losed that there has been an increase in such s tops at the
pilot facilities. Additional information regarding this will be
available following a more comprehensive review.
There is no -empirical evidence that armdng VA police officers
will make VA facilities safe. Likewise,_ there is no single
security feature or law enforcement tool for which there is such
-empirical evidence. As stated above, the firearm is a standard
tool in law enforcement. It is VA's position that if it is used
correctly it can add to the safety of VA facilities.
Ensuring safety within any space (buildings or grounds) is best
accomplished by preventing or limiting access to all or part of
the space. This is contrasted by the need for VA medical care
facilities to be open to the public, at least during business
 245

hours. VA doe. not wiah to limit access unl it becomes

nece. .ary for the safety of all. All VA facilities have some
degree of crime and have been subjected to the introduction of
_apone . Local conditione. which include crime rate in the area
of the facility, on-atation criminal activity, weapon
introductiona and the degree of concern which ~loyaes and
patients have for their safety, determdne the need for the level
of security applied . At aome VA facilitie.~ conditions have been
such as to require the limiting of access and the installation of
weapon screening stations . However , at moat VA facilities access
continues to be without limitation during bUsiness hours. This
can be accomplished because of the continuing presence of
visible, and inquisitive VA police officers who are regularly
patrolling Ilrounds and buildinqs. The presence of a sufficient
number of appropriately trained, supervised and equipped offic~rs
i . the beat way to -prevent crime and thereby achieve safety at VA
facilities.
Qae.t:iOll 2. What are the possible disadvantages, if any, of
ar.ming VA police officer.? What percent of private health care
facilities have armed police "on aite?
au-rs The major risk of arming VA police officers is that
there may be an injury or loss of life of an irmocent party
caused by the accidental discbarg'e or misuse of a firearm . In an
attempt to ~~ze this risk we have selected a specific firearm
and bolster, tbe safety features of wbicb, have been described
and demonetrated to the Subcommittee. Also we have provided
intenaive VA specific training to all of the armed officers
regarding escalation of force and use of deadly force as well as
tbe proper and safe use of tbe issued firearm .
We are unable to provide information regarding' the percentag'e of
private health eare facilities which have armed police because we
are unaware of any source for such information. Regarding the
relevancy of this iasue , it should be recognized that VA
facilities are not private property . They are federal property
and their protection ia the responsibility of the Secretary of
Veterans" Affair":". J.,ocal police do not patrol VA medial care
facilities or provide the continuing unifo~ presence needed to
prevent crime . Local police mayor may not have a continuing
presence at a private facility as they frequently do at state run
health care facilities . When local police have a continuing
presence or when they patrol, they are armed .
Qu tiOD 3s Please give a summary of the VA police officer
workforce . Specifically , how may officers does the VA eB'I>loy ,
what is average pay for such officers, what background and
experience is required to become a member of the VA police force,
and how long has the average member of the force been employed as
a VA police officers?
an-rt Currently there are 1,983 police officers and 43
detectives for a "total of 2,026. The average pay for all police
officers is $27 . 659 . This includes those officers in supervisory
positions. At the journeymen level , which is either GS-5 or GS-
6, the average salaries are $23 , 524 and $25 , 882 , respectively .
The hackllround and experience required to he a member of the VA
police force are exactly the same as for anyone who becomes a
police officer in tbe GS-083 Police Officer Series .
VA does not _intain a data base which can provide information
regarding how long the average member of the force bas been
eq>loyed .a a VA police officer. As a repreaentative 8~ling,
we conducted a lIIIIllual review of the averalle time that a hadqe was

2
 246

i.aued to officers at the Little Rock and Dallas VA medical

centera and determined it to be 2 . 5 years .
a.eloa., What percentage of the VA police force conaists of
retired law enforcement officers?
~. VA does not maintain a data base which can provide this
information. 1io.ever, aa a sampling , we did accoapliah a manual
review of quea~ionnaires c~leted b th~ 218 mOst recent
attendees of our basic traiDing course at the VA Law En.forc~t
'Training Center (LETC) . 'fbe results of the review are that 190
of those officers had qualified for their position ". based upon
prior law entorcement ~rience in the military or with & state
or local law enforcement ~gency .
QuUOD 5. Have rigid . qualification standards always been in
place at the VA? Por example, have all current member of the VA
police force been subject to the same physical fitness
specifications?
~rl Police officers employed by the Department must have met
the Office of Personnel Management qualification standards in
effect at the time of employment. VA also bas had requirements
that pre-employment screening be accomplished on each applicant .
As you are aware, VA Office of Inspector General Audits conducted
in the late 1980s disclosed that neither the qualification
standards nor the pre-employment screening were being rigidly
applied . Since those aUdits, VA has made significant efforts to
ensure that all standar4s and screening are being soundly
applied . Physical fitness specifications, per se, are different
from. qualification standards. VA has, for years, required that
VA police officer applicants and incumbents (annually) meet
specific medical standards. Applicants and inc~ts are
examined to dete~ne their physical and emotional stability" to
perform the functional requirements of their position . Iii"" terms
of physical fitness standards , we have recently :added a
requirement for students attending th~b&8ic police training
courae at the LETC' . All eng~ge in physical fitne,ss tr~ining
during this c ourse and must successfully complete a physical
fitness test designed using standards established by the American
Heart Association.
Qu tloa ,* 'The background information provided to the
Subcommittee staff by the VA indicated that 106 officers have
been issued firearm weapon cards . What criteria did you use to
decide which officers were suited to take part in the pilot
program, and what training was provided to these officers?
&a8wer: Department policy . requires an officer to undergo a
physical and psychological evaluation prior to participation in
the pilot program, and the psychologist ' s recommendation is the
determinative factor in the selection process . The officer must
also have successfully co~leted the Basic VA Police Officer
Training Course at the LETC, the firearms training course
provided by the LETC staff, and must be physically qualified,
emotionally stable and free of any significant criminal record .
The firearms training provided consisted of a 40 hour training
course. The training unit itself was provided to the
SUbcomm.i.ttee prior to the hearings. An additional copy is
attached .

Queatioo 71 Mr . Baffa indicated that the total cost of the pilot

program at the five current sites is $124 , 000 . Does this amount
also include the training that you indicated will be required of
these officers to remain proficient? 1.f not, what do you

3
 247

est~te will be the coat of providing refresher training to

these officers?

~r' No, the $124,000 figure does not include any coats
connected with inservice training. Much of the training will not
require additional expenditure, such as uae of force and practice
drawing from the security holster. The only additional cost will
be for such things as targets and ammunition connected with range
training. We estimate that the cost for these items will be
approximately $100 per officer, per year.

Qu tion 8a VA Directive 0720, Appendix A indicates that a

firearm will be issued only to those persons appointed as police
officers who have successfully completed the PBI-approved basic
VA training course , and PBI-approved firearms training. The
FBI ' s testimony indicates however, that the FBI does not approve
or certify other agency training courses , including firearms
training . Did the PBX actually approve the VA training courses ,
and can you please explain to the Committee what the VA directive
means when it refers to PBX-approved training?
~r, It is our position that this is a matter of semantics
rather than one of substance . It is unfortunate that the
language in VA Directive 0720 was not changed prior to
publication so as to be consistent with the language in the
letters from the FBZ Academy, which confirmed the adequacy of
VA's basic police officer training and firearm training programs .
A part of the process to develop the Directive included meetings
between representatives of the Office of Security and Law
Enforcement (OS&LE) and Office General Counsel (GC) with
representatives of the Department of Justice (DOJ) . The DOJ
representatives strongly recommended certain language for the
Directive including the word -approved- in this particular
section . Subsequent to the Directive being concurred with in its
current form by Departmental elements, VA Partnership Council and
the DOJ representatives , letters were received from both Dr . John
Campbell and Mr . Wade Jackson at the FBI Academy indicating the
appropriateness of the courses but cautioning that they do not
-approve- such training . In retrospect, the language in the
Directive should have been changed but it was not . We believe
that the letters from Messers. Campbell and Jackson (attached)
speak for themselves , and attest to the relevancy of our
training. Also , we know of no Pederal organization which
-approves firearm or basic police officer training of other
organizations . This includes the Pederal Law Enforcement
Training Center (PLETC) .

Qu tiOD!h Testimony from the Nurses organization of Veterans

Affairs (NOVA) suggests .a variety of alternatives to arming
police officers as a means to improve safety and security at VA
hospitals . Por example NOVA's testimony list increased security
personnel during off hours, improved lighting , beepers for
security personnel, badges for all visitors, metal detectors,
bullet proof glass, hidden panic buttons, and closed circuit
televisions cameras as some possible alternatives . Has VA given
consideration to alternatives other than arming VA officers to
enhance safety and security at VA facilities? Xf so, can you
describe what alternatives you have considered and the
conclusions you reached .

~r, In our judgment it is not so much a question of

alternatives as it is one of exploring all options open to the
Department and selecting the appropriate tools or enhancements
that may be suitable. Depending on the circumstances , anyone of
the suggestions made by NOVA mayor may not be appropriate. VA
already requires that bullet proof glass be installed at each

4
Pharmacy and Agent Cashier window and that adequate lighting be
installed at sueh locations as parking lots, building entrances
and pathways. We already use such devices as panic buttons and
elosed circuit televisions where appropriate . However, we
believe that the firear.m, as a weapon for police officers, is in
an entirely different category from the security enhancements
suggested. A weapon is a tool utilized by a police officer to
apply the appropriate force for a given situation. VA officers
are already armed with a cbemical irritant projector and the
side-handle baton . These tools allow an officer to utilize up to
a certain level of force. A firearm al10w8 the officer to use
the highest level of force should it become necessary and only if
it becomes necessary. Without that ,particular tool the officer
is at a oreat disadvantage when confronted by a perpetrator who
is -armed with a firearm . xn such situations the unarmed officer
most often cannot prevail and injuries or deaths may result.
NOVA suggests that VA install panic buttons. When a VA police
officer responds to a panic button, we believe that the VA
officer should be equipped to handle any situation which the
officer mdght confront, including protecting patients and VA
eq;>loyees in dangerous situations . The pilot program is designed
to test whether it is feasible to accomplish this.
QDa8tiOA 10:& 1Ir . Ogden, can you explain to us in detail the
steps VA bas taken to address the serious problems that have been
highlighted in the past concerning the need to closely monitor
the pha~ceutical inventory at the various VA facilities? What
more needs to be done to protect the security of the addictive
drug inventory at VA?

~Z':& Since 1991/1992, the Veterans Health Administration

(VHA) has taken a number of actions to enhance the accountability
of pharmaceuticals at VA facilities. Listed below under four
major categories are those actions:
A. VA policy regarding controlled substances:
A perpetual inventory of all controlled substance
dispensing is required .
Limited access to controlled substances within
pharmacy is required. and documentation regarding
access must be maintained.
The storing and dispensing of controlled substances
must occur within locked areas . Blectronic access
control devices are required for all locations where
controlled substances are stored and dispensed
within the pharmacy.

Verification of perpetual inventory within pharmacy

every 72 hours is required.

A11 completed outpatient prescriptions for

controlled substances must be stored in a locked
cabinet awaiting patient pick-up . Pharmacy staff
must verify the identity of the patient picking up
the medication and the patient or patient's agent
must sign for the medication.
A taJll)er proof seal must be affixed to all
controlled substances prescription vials .
Orders from suppliers for controlled substances are
delivered directly to the pharmacy in unopened
containers. The accountable officer and pharmacy
representative will open container, acknowledge

5
 249

receipt , and poat inventory to pharmacy recorda .

Both the accountable officer and pharmacy
representative will verify inventory posting on
pharmacy records.
Any suspected theft, shortages, or suspicious loss
must be reported i.amediately to the Office of the
Inspector General, VA police , and VA Headquarters .
The VA prescription form has been modified two times
in 1991 and 1993 to enhance the security features.
In addition field facilities are authorized to
generate prescription orders for outpatients via
other internal use mechanisms . These include at
least Electronic Order Entry and alternate paper
order forms such as Action Profiles .

B. Rewrite of VA Narcotic 'Inspection Policy (policy is

written, approved and awaiting publication , copy
attached) :

VHA administrative personnel conduct monthly

unannounced narcotic inspections .

Wards / patient care areas are randomly surveyed.

Inspection results must be trended by the medical

center director and such results are considered one
of the facilities quality management tools .

In the pharmacy, dispensing actions are checked

against p osting by the inspector.

The medical center director must. ensure that a

.training program exists for narcotics inspectors.

A standard timetable for destruction of outdated

controlled substances was established. All
outdated controlled substances must be destroyed at
least quarterly .

At ward level , the inspectors must sarrple

dispensing e ntries against medical administration
records .

Standards for automated dispensing equipment

inspect.i ons and verification were established .

C. Reduction of inventories:

All stock of controlled substances have been

removed from VA warehouses .

Overall pharmacy stock, including controlled

substances, has been reduced through the use of
prime vendor distribution and just-in-time ordering
and delivery.

D. ~loyee Integrity :

An educational video concerning employee integrity

was developed, and released to all facilities . All
new and current pharmacy employees must view the
video .

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 250

Access to pharmacy service by non-pharmacy

personnel baa been limited via directive and manual
change.

Information regarding any theft of pharmaceuticals

will be released to the respective State Board of
Pharmacy.

Regarding other needs for even greater enhancement of controlled

substance accountability, VHA bas two other action items in
process. First, testing of electronic data interchange linkages
between our wholesalers and VA's data base regarding purchases is
ongoing. At this time, VA's data base will accept such data but
at least one vendor is having problema making the interchange
function successfully. Soon, this tool will enable pharmacy
managers to COD'lnlre procurement actions to dispensing actions;
thus enhancing inventory capabilities. Second, controlled
substance accountability for inpatients continues to be addressed
as part of a Material weakness in the Secretary's Annual Fiscal
Manager's Integrity Act report. CUrrent time frame estimated for
completion is Py 1999 based on the availability of internal
resources. This action will enable cOD';)lete documentation of
controlled substance accountability for inpatients and real-time
documentation of medication administration at the patient level.
OUtion 11: Please explain, in detail, the steps VA has taken to
address the serious problems that have been highlighted in the
past concerning the need to closely monitor the pharmaceutical
inventory at the various VA facilities? What more needs to be
done to protect the security of the addictive drug inventory at
VA?
aa.w.r: Please see answer to question 10.
QuUOD 12: The written testimony provided by the American
Federation of Government Employees (APGE) raises serious
questions concerning unacceptable response times and severe
staffing shortages at VA fire departments. Are VA patients,
employees and firefighters at great risk, as APGE and the other
firefighter unions suggest, and is it true that the situation at
most VA fire departments can only be characterized as an accident
waiting to happen?

aa.w.r: No. Patients, eJII)loyees and fire fighters are not at

-great risk- at VA Medical Centers with in-house fire departments
as claimed by the testimony provided by AGPE. Nor is it true
that the conditions at, these facilities can be characterized as
-an accident waiting to happen.-
VHA runs a comprehensive fire protection program at all VA
facilities. We believe the results are evident in the
Department's good record on fire loss experience. All VA fire
departments are required to have in place mutual aid systems
which permit facility fire fighters to, ,promp~ly sUJllllOn assistance
from outside departments should it ever be required. By the end
of the current fiscal year, all VA Fire Departments will have
received an in-depth evaluation which reviews staffing levels,
equipment, training and response capabilities. VA Fire
Departments are expected to respond to a fire at any location
within the medical center in a shorter time frame than is
considered acceptable from a community fire department. (VA
requirements for fire protection include a response to a medical
center by a community fire department with arrival of their fire
apparatus within eight minutes. In contrast, VA fire departments
are expected to be in position to initiate fire suppression
within eight minutes with hose lines deployed. During the 117
interior drills conducted to date, VA Fire Departments have

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averaged such a response in 7 minutes and 26 seconds. Most of

our departments are capable of even better performance than this,
with sst of the departments evaluated to date averaging less than
7 minutes . The fastest drill time observed was 3 minutes and 47
seconds . . Twenty-five percent of the drills have taken less than
5 minutes and 30 seconds) .
With few exceptions, VA Fire Departments typically provide a
prompt and effective response to incidents at their facilities,
which enables the rapid extinguishment of any fire discovered.
In addition, many VA facilities are completely protected with
automatic fire sprinkler systems which by themselves provide a
greater level of protection than is required by National Fire
Protection Association standards . The prompt response by VA fire
fighters, especially when accompanied by a complete automatic
fire sprinkler system at a facility, serves to keep almost all
fires which do occur within the ~ncipient stage, and results in
these fires being promptly extinguished with an absolute minimum
amount of property damage or risk to our patients. It is
important to note that, while the number of alarms to which a VA
fire department responds may be quite high, the number of actual
fires, including such things as overheated computer monitors ,
trash can fires, etc. is very low. This is because, at those
facilities which operate a VA fire department, medical center
staff have been trained and repeatedly reminded to call the fire
department whenever anything unusual is observed or detected.
Consequently, VA fire departments typically run dozens of ' smell
of smoke" and similar calls for every incident where an actual
fire is present. These calls are typically caused by lint on
steam radiators in the fall, overheated fluorescent light
ballast's, etc. As such, these incidents pose no threat to
patients or staff, however they do show up on fire department run
sheets as an excessively high number of fire calls.
Regarding concerns in the written testimony on staffing levels
and allegations inVOlving OSHA regulations, VA fire departments
are staffed to provide a minimum of four fire fighters per shift
and are required to operate in compliance with all applicable
OSHA standards.
All on-site VA fire departments must comply with all applicable
OSHA (occupational Safety and Health Administration) and NFPA
(National Fire Protection Association) regulations regarding
occupational safety and health of fire fighters . Current OSHA
criteria for the fire service does not establish any minimum
staffing levels for fire departments . However, OSHA does require
that a minimum of four fire fighters be assembled before an
interior structural fire attack can be made on a fire beyond the
incipient stage (use of hose lines greater than 1-1/2 inch and
use of self contained breathing apparatus).

VA has allowed an exception to the four man staffing standard for

a VA fire department via an equivalency process. Themedical
center may be granted an equivalency permitting on-duty VA fire
department staffing to drop to a minimum of three trained,
professional fire fighters on duty at all times under the
following conditions :
(1) All structures housing patients overnight are fully
protected by an approved, automatic fire sprinkler system
installed and maintained according to NFPA standards; (2) all
structures housing employees and their families overnight are
equipped with hard wired smoke detectors; (3) local fire
departments with which a mutual aid agreement exists are capable
of providing prompt "back-up" to the facility fire department
during an emergency; and (4) the medical center fire department

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has a written protocol requ1r1ng the summoning of mutual aid

assistance immediately whenever an actual fire is discovered.
The primary rationale for this equivalency is based upon the
presence of the approved automatic fire sprinkler system
throughout the patient occupied buildings. The presence of a
complete automatic fire sprinkler system in a facility
substantially exceeds NPPA requirements for life safety in an
existing healthcare facility. Extensive documentation by the
NPPA (National Fire Protection Association) confirms the
effectiveness and efficiency of automatic sprinkler systems. In
fact, NPPA records contain no incidents where a fire occurred
which resulted in multiple fatalities ina structure protected by
an approved and properly maintained automatic fire sprinkler
system. Sprinklers, by their design, control and limit the
spread of fire . Accordingly, individuals within a sprinkler
protected structure are far safer than those in a structure
lacking this important feature. Because of this additional level
of life safety, the equivalency process within VA was initiated
several years ago. By employing this equivalency, a medical
center may achieve a recurring cost savings of up to $120,000 per
year without adversely effecting the level of life safety
provided for our patients, visitors, and staff. VA has been
working for several years to achieve complete automatic fire
sprinkler protection within our patient occupied buildings.
VA's fire department staffing equivalency process does not
conflict with OSHA policy on the occupational safety and health
of fire fighters. These equivalencies are to VA policy regarding
the level of protection provided to patients housed overnight in
our facilities. Automatic sprinkler protection may reasonably be
expected to control the spread of any fire which does occur,
preventing the fire from growing beyond the incipient stage
before fire fighters are on the scene. In addition, and to
insure the capability of dealing with a major fire, VA fire
departments with equivalencies in place, are required by written
policy to immediately summon mutual aid assistance whenever a
fire beyond the incipient stage is encountered and to refrain
from fighting a fire beyond the incipient stage when only three
fire fighters are present.
Of the thirty VA fire departments, ten currently have staffing
equivalencies permitting them to operate with a mi,nimum of three
fire fighters on duty at all times. These ten medical centers
are: (1) Canandaigua, NY; (2) Martinsburg, WV; (3) Hampton, VA;
(4) Murfreesboro, TN; (5) Tomah, WI; 16) Knoxville, !A; (7) North
Little Rock, AR; (8) Ft. Harrison, NT; (9) Sheridan, WY; and (10)
Chillicothe, OH,

The information provided by the APGE in the written testimony

concerning specific facilities is not correct. The testimony
references the American Lake Division of the VA Puget Sound
Health Care System, stating that they received an award last
September as the best VA fire department but that now they are
being eliminated through a sharing agreement with Fort Lewis Army
Base. The facts pertaining to this facility are somewhat
different. First, there was no award for "the best VA fire
department." The department at American Lake was evaluated last
year under the VA Fire Department Evaluation program and did show
very good performance, with one observed drill, having a time of
3:55 minutes, being the best ever observed up to that point in
time . OVerall performance of this department was rated as "very
good." Other claims regarding this facility are addressed in the
answer to Question 14 . The information about the agreement with
Fort Lewis is accurate.

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 253

The information provided. in the testimony for the other stations

is also incorrect. At Chillicothe, Ohio, VA Medical Center for
example, the department's maximum on duty staffing is 5, not the
7 noted by Al'GE. The minimum number of on duty fire fighters has
consistently met VHA's minimum requirements and is fully adequate
to operate the department's equipment. There is no lake at
Chillicothe, nor does this department perform boat rescue. While
there is a volunteer fire department in the area, there is also
an extremely high quality, paid professional fire department with
a minimum of 12 on duty personnel located slightly over four
miles from the -clica1 center and capable of responding to the
facility under mutual aid in 9 minutes or less .
VAMC Ft. Meade, South Dakota, is a 250 acre facility, not 8,000
acres. The facility fire department does provide fire
suppression to several thousand acres of BLM wild lands on a
contractual basis. This was initiated by the facility fire
department many years ago in order to improve the department's
cost efficiency, and has never proved a problem for the Medical
Center. The written testimony by APGE on staffing numbers are
accurate, however, this is a department where the fire fighters
work a 72-hour week (24 hours per week per man more than the VA
norm), and staffing is fully adequate to maintain a minimum of
four fire fighters on duty at all times.
VAMC Battle Creek, Michigan, has repeatedly explored the
possibility of combining Police and Fire Fighter positions,
however, they have been instructed by VHA Headquarters' Security
and Law Enforcement Service, Engineering Management Office, and
Human Resources Office that this is not a workable solution.
The facility is protected throughout by an approved automatic
fire sprinkler system, and a total of 4 (not one) outside fire
departments are in the area and can be summoned for assistance
via mutual aid when necessary.
The cOlllllents concerning VAMC Sheridan, Wyoming, being "staffed so
it can operate it's three pieces of equipment on TuesdayS" is
confusing. Equipment at Sheridan consists of one 1250 gpm
p~er, one 250 gpm brush rig and an ambulance. These units all
serve completely different purposes, and there is neither the
intention nor the need to "operate it's three pieces of
equipment" at the same time. Staffing at this department is
below the normal 14 shift personnel and a chief, however, here
again this department operates on 72-hour tours of duty,
therefore, requiring less staff. The available staffing at
Sheridan is sufficient to permit.the facility fire department to
maintain the minimum level of coverage required by VA policy.
The above information should clarify the concerns raised by the
APGE. VA Fire Departments do provide a wide range of services to
our Medical Centers, .and, when operating as intended, are a real
asset to the facilities in dealing with the full gamut of
emergency situations which a Medical Center may encounter. VA
Fire Departments are professional, dedicated organizations. In a
very real sense, VA Fire Fighters are the nation's "experts" in
healthcare fire fighting, as was shown last year when the
producers of the Fire Service training series "American Heat"
chose to utilize the VA Fire Department at TOgus, Maine as a
source of expertise when preparing a video training program on
healthcare fire fighting which has been distributed worldwide.
VA is extremely proud of its record of fire safety and of the
ongoing fire prevention programs which provide this high level of
safety to our patients, visitors, and staff. Our VA Fire
Departments play a significant role in these programs at those
_dical centers which operate in-house fire departments. VA Fire
Departments also provide an extremely quick initial attack to any

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fire which does occur . Tbi. in turn has the effect of limiting
the spread and scope of any such fire and significantly enhances
the overall level of fire safety at the facility. The
combination of a e~rehenaive fire prevention program, coupled
with the pre8ence of a VA Pire Department, provides a
aignificantly higher level of life aafety to our patients and
staff than may be found in most medical facilities .
auSSUOD 13 : The International Association of Fire Fighters
(XAPP) contacted our Subcommittee staff with serious concerns .
They claim the VA is focusing too much attention on contracting-
out VA fire protection, with little, if any, attention being paid
to cost effectiveness and patient safety . Por example, the lAPP
indicated that five separate VA-commissioned coat assessment
studies indicated that the VA could most efficiently provide fire
protection by using its own fire department, yet the VA went
ahead with contrac ting out plans . Can you speak to these
concerns?
~r: Without benefit of the specific information submitted to
the Subcommittee staff by the LAPP, we are unable to substantiate
any specifics conditions in these claims. In the Veterans Health
Administration'. (VHA) Prescription Por Change , one of the
objectives i . to focus management attention on VHA ' s key business
of providing health care . With this in mind. one of the a c tions
in the Prescription For Change to accomplish this objective is to
continue to explore opportunities for contracting out fire
suppression services where possible. Of the seven medical
centers to eliminate their in-house fire departments within the
past ten years. only two medical centers have contracted out for
fire suppression. 'l1le Americ an Lake Oivision of the VA Puget
Sound Health Care System contracted out for fire suppression
services through a sharing agreement with the Port Lewis Army
Base in June 1997 as addressed in Questions 12 and 14. The
Livermore, CA Division of the VA Palo Alto Health Care System
contracted out services in 1996 to the local county fire
department. In both cases, the individual medical centers will
achieve cost savings without iJrpacting the level of safety for
patients, employees and visitors . All other closures of VA fire
departments in the past ten years have been accomplished with the
local coamunity taking responsibility for fire suppression
services at no cost to VA . This responsibility was transferred
when the communities and their fire deparbftents grew to the point
where they were capable of meeting minimum VA requirements for
fire suppression and they had a legal obligation to provide the
service . We believe in all cases, safety of VA p,tients l

employees , and visitors have not been compromised .

aut.1OD16: The American Pederation of Goverrunent Employees
(APL-CXO) contacted the Subcommittee staff about the recent
decision to contract-out fire protection suppression at the VA
Medical Center at American Lake . Pleas~ provide the ~ubcommdttee
with the annual coat of operating the American Lake VANC fire
department and the annual value of all other services previously
performed by the fire fighters including back-filling for police
and safety officers. Also, explain what iq>act the decision to
eliminate the American Lake VANe fire department will have on the
quality of care provided to veterans as well as the risk of loss
of or injury to life and property .

~: The average annual coat (salaries) of operating the fire

deparbaent at the American Lake Division of the VA Puget Sound
Health Care Sy.tem over the past year was $469,900 . The annual
coat of the contract with Port Lewis Army Base to provide fire
suppression services is $165,900 with the cost to be adjusted
annually by CPl. The contract is effective through June 20,
2002. The coat for recurring maintenance and testing of fire

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protection ayat_. previoualy conducted by the fire doopartment.

will be approxt.ately $20.000 per year.

The annual value of all other 8ervices previoualy .perfon.d by VA

fire fighters encompaS8es .everal elementa . Kany of the
additional aervicea they ~rovided were due to the fact thet they
were available 24 hours a day. Theae duti.s conaisted of such
activitia facilitating snow removal. reaponding to disruptive
behavior calls, etc. Thes. duties are now rea.signed to other
ataff at the facility with no degradation in response or increas.
in cost. TWo positions that did not previously exist have been
created to replace some fire department services in the safety
and escort functions, and additional funding will be needed to be
allocated to cover same maintenance and repair funetiona and
laundry delivery that will no longer be covered by the fire
fighters . The cost for these positions and the additional
coverage is estimated at $85.798 per year . The total cost of
providing the same level of protection ia $271,698 .s compared to
$'69.900 for the in-house fire department .
Two additional police positions were recently authorized and are
not related to the termdnation of the facility'. fire department.
A review of the police staffing determined that a min~ of
three police officers at the Seattle Division and two at the
American lake Division ahould be on duty at all t~s to assure
the . safety of eD'I>l:oyees and .ecuri ty of property. These
functions can not be accomplished by the fire fighters since they
do not have law enforcement authority.

Tbe decision to contract out fire suppression services at the

American Lake Division will have minLDal ~ct on the quality of
care provided to veterans at this facility, aa well as the level
of .afety and property protection. The response by the Port
Lewb ArIQy Baae fire depere->t i8 e.timated to be _11 within
our miniDum fire department response requirement of eight
minutes. '!'be North Port Lewis fire atation (one of four on the
baae) i. on property adjacent to the American Lake Division . The
fire erew ~ responding to calls at the American Lake Division viII
travel a dedicated paved road of about one mile . A IIlUtual aid
agreeaent i. also in effect between the Port Lewis ArIQy Base and
the Pierce County fire deparbBent to provide back up aupport at
the VA ahould the need ariae (8ee attached decision). This
decision was made after a thorough analysis of all i.sues. The
decision to cl08e the facility, fire deparbDent vas not meant to
demean the out8tanding efforts of the profeaaional fire fighters
who ataffed the _rican Lake Division fire depar~t . All ten
fire fighters, including the five teq>oraries, were offered
poaitiona at the facility. Bight have elected to r_in. one has
chosen to take a position elsewhere in VA and another declined a
position . The additional cost savings generated by this decision
.ill be effectively used to enhance care to our patients. Tbe
American Lake Division will join the other 143 VA .edical ~ Center.
who receive fire suppression services from local community fire
depertaoenta .

OIleR!..... 15. Deacribe the purpose of oversight of police

operations at medical facilities, describe how this oversight is
conducted, the information gained from oversight and the changes,
if any, which have resulted from this information? How
frequently is overaight conducted?

aa.w.r. The purpoae of oversight of police operations at medical

care facilitie8 is to determine whether the conduct of those
operationa are conaistent with VA policies . Periodic on-sight
i.Jwpectiona are conducted of each local police operation by an
i.n8pector from OStcLB, utilizing a standardized lnapection Guide
containing over 100 criteria of policy requirements and

12
 256

_ctationa. The finding. and r e c _ t i o n a of the

ina~ctiona are Bent through the .Chief Network Officer to the
facility director for action. Tbe facility reaponda with an
implementation plan. If ~ facility reBponae i. conaidered to
be inadequate in any sionificant way. a repreaentativ. of 0SIcLB
_kes an appropriate follow-up. Changes that have resulted are
facility focused, making them difficult to identify overall.
Generally, however, the inapection process has aided in focusing
significant attention on security and law enforcement i ues
Department-wide.
The average time between inspections at any given facility is
currently 4. . 2 years . Since this i . an average, some are
inspected more frequently than others. If a facility is
considered unsatisfactory when inspected, an inspection is
conducted again in about one year . Conversely, if a facility is
considered highly satisfactory, it will likely be more than 4.2
years before it is inspected again .

au-atiOD 1ta Describe the ~rovements in local police services

at VA facilities during the last four years . Have these
improvements been made at all VA facilities?
aa.w.~, Aa stated in the oral testimony we believe VA has made
important improvements in local police services during the last
four to six years .
We believe that a key to improving our individual police and
security operations is to focus on ensuring that our facilities
have a sufficient number of qualified and physically functional
police officers , who are appropriately trained, supervised and
equipped to provide protection and law enforcement services. One
method used to facilitate this is to significantly expand and
iJrorove our training curriculum. The basic training course was
expanded. supervisory training was added to the curriculum. and
legal and behavior specialists are now a part of our training
center staff . We now provide much improved training to our basic
officers and we provide a training course for our new chiefs,
annually . To improve services provided at the facilities , we
have tailored our inspection proce ss to focus on certain critical
elements of a police and security operation . These include
ensuring that the appropriate nUlflber of officers are on duty,
that there are workable communication procedures to ensure timely
response, that pre-employment screeninq requirements are being
accomplished, and that both initial and annual physicals and
psychological assessments are being accomplished . Other critical
elements include ensuring that inservice training is being
accomplished, that law enforcement activities are being
accomplished in a legally and technically correct manner, that
each operation has a current and comprehensive standard operating
procedure and that annual physical security surveys are being
completed. By focusing on these critical areas and being
inaistent in our inspection process that they be corrected, we
have assured that better services are being provided locally.
To answer the second part of your question, as acknowledged in
testimony given , all facilities are not equal in the level of
iq)rovements IMde . But we have made significant progreas and we
hope to continue to do 80 as we go forward with the program.

QutiOD 17, How many hours a month do VA police officers devote

to maintaining their proficiency with firearD\8 and what are the
direct and/or indirect costs associated with maintaining
profiCiency? There are two pilot sites in Chicago, how.any
hours a month do Chicago lI'IW1icipal police devote to maintat.n ing
their proficiency with firearm8?

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a.a-z. ~
number of hour. and coata for training V). officers
vaxy frOlll -.nth to IM>I1th .
A Specific nWllber of hour. baa not
been established .
However, there is periodic, mandatory and
rec-.ded training.

A. Mandatory refr.sher training for armed VA police

officers conaiata of the following:
Semi-annual range qualification;
supervised monthly training for uniformed officers
in safely drawing the firearm from the security
holster;

supervised monthly training for all officers in

handgun retention; and

quarterly training on escalation of force and the

uae of deadly force .
. 8 . Recommended training for armed officers conai.t.
of the following :

supervised quarterly range training , b a certified

firearme instructor;
supervised judgmental training utilizing the Firearm
Training System or similar system; and

supervised training in firing in reduced lighting.

A ~contactwith the Chicago Police ~ Department revealed that there
is no periodic firearm proficiency training. That Department
requires only annual range ,qualification. A check with the Cook
County Hospital Po~ice revealed the same, and a check with the
university of Illinois Police revealed only a semd-annual range
qualification .
gue8tiOD 18, During the pilot project, has any VA police officer
drawn his or her firearm? Has lethal force been used?
~r, To date, there have been three occasions in which VA
police officers have drawn their firearm. on one of the
occasions an officer drew her firearm when making an arrest of a
burglar; on one occasion one of two officers (both armed) drew
his firearm when approaching an individual with a handgun that
had just been discharged; and on the third occasion one of two
officers (both ,a rmed) drew his ' firea~ when .approaching an
-individual . who had been reported to be armed. To date no VA
police officer has discharged his or her firearm, except on the
firing range, and no lethal force has been used.

gg.8tiOD 1',As I understand your statement, there is evidence

that . VA police officers at .pilot sites were exercising more
vigilance in the key areas of investigative stops and car stops.
How .do you explain this reported finding? How significant were
the changes identified? What steps can be taken to insure VA
police officers at non-pilot sites exercise more vigilance in the
key areas of investigative stops and car stops .

~, As indicated in the response to . question number 1, there

is justified concern on the part of . our officer. for their own
safety when approaching. auspicious person. This i . a180 the
case when approaching a vehicle which has been stopped because
the driver i. believed to have violated a traffic law or because
of some other reason. Thi. concern is significantly multiplied

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when light is low and visibility, is poor. One simply does not
know what type of a weapon a suspicious person or a driver
passing through VA property may be carrying if any. OUr o1:ficers
are well aware from experience that persons do enter VA buildings
and grounds with a variety of weapons capable of being used
lethally and that the officers may well be at a significant
disadvantage. When these officers believe that they would have
at least an even chance should the person they stop be armed,
they are more likely to make the investigative stop or car stop.
The findings to date are preltminary, but most facilities have
shown some increases in these areas. All showed some increases
in the number of car stops, and three of the five showed
increases in investigative stops. The most significant increase
was at West Los Angeles, where the number of car stops were
estimated to have increased from 109 to 323 for the period
evaluated. A large volume of drive through traffic at West Los
Angeles is a significant issue which VA police must confront.
Many of these persons are speeding and causing dangerous
situations for pedestrians. The acting Chief at West Los Angeles
has indicated that since officers there have been armed, he no
longer has to seek out officers to operate the radar detector.
He now has volunteers on each shift, everyday.

Officers at non-pilot sites can be encouraged to exercise more

vigilance in the key areas of investigative stops and car stops
by putting requirements in their performance plans that they do
so. However, this will not change the situation of having police
officers knowing they are at a potential disadvantage if they
encounter an individual who is in possession of a firea~ or
other lethal weapon. It is well accepted that investigative
stops and car stops are among the three most dangerous situations
for police officers, with the third being domestic disputes. VA
police officers know that these are dangerous situations and they
know that all killings of other VA officers by gunfire have been
during investigative stop type incidents. VA officers as are all
law enforcement officers are, quite cautious when encountering
potentially dangerous situations.

gu,tiou. 201 According to your statement, -VA's 160-hour basic

course appeared to be consistent with the standards established
by the Pederal Law Enforcement Training Center (FLETC) and at
several state academies. Is VA's 160-hour basic course
consistent with the standards established by FLETC and at several
state academies? In what respect is it not?

an-Z'I As indicated in the response to question number 8, as a

part of the development of the pilot program, we requested a
review of our training programs by the FBI Academy. In
accomplishing this, we supplied voluminous material regarding our
basic police officer training program to John Campbell, Ph. D. ,
PBI AcadeD Academic Section Chief. Dr. Campbell had agreed to
review the basic 160 training course to compare it to ,the basic
officer training course offered at FLETC. By correspondence
dated April 29, 1996, Dr. Campbell responded to our request.
This response (attachment to Question '8) was the basis for the
statement in VA's testimony. Dr. Campbell c~red our course of
training to similar curriculum design for PL2TC and for .. several
state academies." Dr. Campbell indicated that our 160 hours
course, -_appears to be consistent with the standards established
by the aforementioned training courses. The curriculum design is
appropriate and the reference material, both books and documents,
are consistent with those reference materials utilized in Basic
OfficeZ's Training.- Dr. Campbell continued, -_the Basic Training
Course for VA police officers appears to be relevant and
consistent with basis law enforcement training; however, the FBI

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Academy at Quantico, Virginia. does not certify ~r accredit the

be.ie law enforcement training course , -
we believe that our basic police officer course is consistent
with standards established for basic police officer training,
whether it be standards of PLB'I'C or standards established by
state academies. Since we did not accomplish the review we are
not able to say in what way Dr . Campbell may have believed that
our training was not consistent with standards of FLBTC or those
established by state academies . We can say that Dr . C~bell
made no recommendations to us for tmproving our course of
training.

Add! tianally , the basic police training course provided to newly

appointed VA police officers has Lmportant unique features when
compared to traditional law enforcement training . In the
training provided at the LETC special emphasis i . placed on
dealing with patients~ diffusino hostile and aggressive behavior
with the minimum use of force and providing customer service.
Students are taught that their role in the medical center setting
is that of a police officer who is skilled to protect their '
clientele and to function as an integral part of the patient
treatment team .

16
 260

ATTACHMENT TO QUESTION #6

DEPARTMENT OF VETERANS AFFAIRS

LAW ENFORCEMENT TRAINING CENTER

NORTH LITTLE ROCK, ARKANSAS

FIREARMS
TRAINING UNIT 18
 261

TABLE OF CONTENTS

CONTENTS PAGE NUMBER

1. Purpose, Application and Objectives

2. Use of Force 2

3. Role'" Specifications of the Semiautomatic Pistol 6

4. Transitional Pistol Training 7

5. Operation 14

6. Coune of Fire 20

7. Care'" Maintenance 26

8. Shooting Review Procedures 29

9. Post Shooting Proeedures 32

10. Check List 37

11. Armorer's Report 42

This Training Unit has been prep:ued solely for Ih~ purpfl5c of inlernal Dcparllllcnlalusc.
It is nol intended to, docs nol, and may nul be rcli~d upon 10 creale any righls, subslantive
or prnceduraL enfnrceahh: at ..,'" by an~' part;.-' in any Ina ller . toj"il or criminal. and dnes
nnl place any lilllilatinllS (UI (llher wist lawflll :lcli'.- ilil' '' (If Ilw I kpartl1h' nl
 262

Part I

PURPOSE. APPLICATION AND OBJECfIVES

I. PURPOSE: The purpose of this Training Unit is to describe authorized and prohibited
uses of a firearm by police officers; to provide guidelines on the use of force, to include
deadly force, and to establish training and qualification requirements.

2. APPLICATION:

a. This program must be SUCCESSFULLY completed by every police officer prior

to the issuance of the Department approved firearm. No deviation from program requirements
will be authorized.

b. Each police officer authorized to carry a firearm must be provided with a copy of
this unit for personal guidance.

3. OBJECfIVES:

a. To establish guidelines for thc training, issuance and use of the Department
approved firearm.

b. To prescribe conditions justifying the use of the firearm and rules of engagement.

c. To establish procedures for reporting and reviewing the use of the firearm.

d. To establish qualification requirements.

 263

I'ART II

USE OF FORCE

1. INTRODUCTION:

a. V A Policy requires that the use of deadly foree by VA police officers be consistent
with the guidance from the Department of Justice. On October 16, 1995 the Department of
Justice issued a directive concerning the use of deadly foree. The-following information is
consistent with that directive.

b. The Department of Veterans Affairs hereby establishes unifonn procedures with

respect to the use of deadly foree. This section will provide practical guidance for officers
who must make grave decisions regarding the use of deadly foree under the most trying of
circumstances. It has always been the philosophy of the Department of Veterans Affairs that
only the minimum amount of foree necessary be used by VA police officersto control violent
situations. The addition of a fireann as an equipment item for VA police 'does not indicate
any modification in that philosophy. VA police officers who carry a fireann are expected to
make every attempt to de-escalate violent and potentially violent situations with the minimum
amount of foree: The safety of all persons in the area of an incident is of paramount
importance.

2. _PRINCIPLES ON THE USE OF FORCE:

a. The Department of Veterans Affairs recognizes anO respects the integrity and value
of all human life. ConsistenJ with that primary value, but beyond the scope of the principles
articulated here, is the Department's full commitment to take all reasonable steps to prevent
the need to use deadly foree, as reflected in Departmental training and procedures. Yet even
the best prevention policies are on occasion insufficient; as when an officer serving a warrant
or conducting surveillance is confronted with a threat to their life. With respect to these
situations and-in keeping with the value of protecting all human life, the touchstone of the
Department's policy regarding the use of deadly force is~. Use of deadly force must
be objectively reasonable under all the circumstances known to the officer at-the time.

b. The necessity to use deadly foree ariscs when all other available means of
preventing imminent and grave danger to officers or other persons have failed or would be
likely to fail. Thus, employing deadly force is pemlissible when there is no safe alternative to
_using such force, and without it the officer of others would face imminent and grave danger.
Officers are not required to place themselves. another officer, a suspect, or the public in
unreasonable danger of death or scrious physical iniury before using deadly force.

c. Determining whethcr deadly force is necessary may involve instantaneous

decisions that encompass many factors, such as the likelihood that the subject will use deadly
force on the ofliccr or others if sllch force is not uscd by the officer; the officer's knowledge
_that lhe sllbject will likely aC(ll1iescc in arrest Of rcc~pturc ifthc -officer uses lesser force or no
force at ,III; the ,-apahilities of the suhjcc\: Ihe suhje,"'s access II) cover ~nd weapons; Ihe
 264

presence of other persons who may be at risk if force is or is nOI used; and the nature and the
severity of the subject's criminal conduct or the danfler posed ,

d . Deadly force should never be used upon mere suspicion that a crime, no matter
how serious, was committed, or simply upon the officer' s determination that probable cause
would support the arrest of the person being pursued or arrested for the commission of a
crime. Deadly force may be used to prevent the escape of a fleeing subject if there is probable
cause to believe:

(I) The subject has committed a felony involving the infliction or threatened infliction
of serious physical injury or death,

(2) The escape of the subject would pose an imminent danger of death or serious
physical injury to the officer or to another person.

C. As used in this training unit, "imminent" has a broader meaning than "immediate"
or "instantaneous." The concept of , "imminent" should be understood to be elastic, that is,
involving a period of time dependent on the circumstances, rather than the fixed point of time
implicit in the concept of" immediate" or "instantaneous." (Thus, a subject may pose an
imminent danger, or has a weapon within reach, or is running for cover carrying a weapon, or
running to a place where the officer has reason to believe a weapon is available).

3. LESSER MEANS:

a. Intermediate (orce. If force less than deadly force could reasonably be expected to
accomplish the same end, such as the use of the ell' or the sidehandle baton, without
unreasonably increasing the danger to the officer or to others, then it must be used. Deadly
force is not permissible ifless force will control a violent or potentially violent situation,
although the reasonableness of the officer's understanding at the time deadly force was used
shall be the benchmark for assessing applications of this policy.

b. verbal Warnings. Before using deadly force, if feasible, officers will audibly
command the subject to submit to their authority. Implicit in this requirement is the concept
that officers will give the subject an opportunity to submit to such commanl! unless danger is
increased thereby. However, if giving such a command would itself pose a risk of death or
serious physical injury to the officer or others, it need not be given.

c. Warning Shots And Shooting To Disable.

Warning shots are prohibited. Discharge of a lirearm is usually considcrcd 10 be

permissible only under the same circumstances when deadly force may be used . . Ihal is,
only when necessary to prevent loss of life or serious physical injury. Warning shols
themselves may pose dangers to the officer or others. Attcmpls to shoot to wound or to injure
arc unrealislic and bcclmsc of high miss rales .",,1poor Slopping effectiveness, can prove
dangerous '(lr the oflicer and olhcrs. Th.:rchll c. shuulint: merely 10 disablc is strongly
t..li~c(nlrap,cd .
 265

d. Motor Yehielc:s And Their Occupants.

Experience has demonstrated that the use of firearms to disable moving vehicles is either
unsuccessful or results in an uncontrolled risk to the safety of officers or others. Shooting to
disable a moving motor vehicle is prohibited. An officer who has reason to believe that a
driver or occupant poses an imminent danger of death or serious physical iqjury to the officer
or others may fire at the driver or an OCcllPBnt only when such shots are necessary to avoid
death or serious physical injury to the officer or another, and only if the public safety benefits
of using such force reasonably appear to outweigh any risks to the officer or the public, such
as from a crash, ricocheting bullets, or return fire from the subject or another person in the
vehicle. Except in rare circumstances, the danger permitting the officer to use deadly force
must be by means other than the vehicle.

4. USE OF DEADLY FORCE:

a. PERMISSIBLE USES:

(I) General Statement. Police officers of the Department of Veterans Affairs may use
deadly force only when necessary, that is, when the officer has a reasonable belief that the
subject of such force poses an imminent danger of death or serious physical injury to the
officer or another person.

(2) FLEEING FELONS. Deadly force may be used to prevent the escape of a
fleeing subject if there is probable cause to believe: :

(a) The subject has committed a felony involving the infliction or threatened infliction
of serious physical injury or death; AIll1

(b) The escape of the subject would pose an imminent danger of death or serious
physical injury to the officer or to another person.

b. NON - DEADLY FORCE. When force other than deadly force reasonably
appears to be sufficient to effect an arrest or otherwise accomplish the law enforcement
purpose. deadly force is not necessary.

c. YERBAI. WARNINGS. If feasible and if to do so would IIqt increase the danger

to the officer or others, a verbal warning to submit to the authority of the officer shall be given
prior to the use of deadly force.

d. WARNING slm.IS.~WAItNII'G SIIOTS ARE. PROHIBITED.

e. VI~III.Q..ES.

( I) Experience Illls demonstrated th:!! th.: lise of lir~anlls to disable moving vehicles is
either IIllSUCC('ssrul or rcsuhs in iUl \1Ilcunlro!kd n :k ttl the sakty of nUiccrs or nthcrs .
Shun.in:: In .Iis~,hlc ~ IIHtvill~ IlIolnt' ,..-hid\.' is pn,hihih,1. ,\u "nin'" who has rcasnn to
1
 266

belicvc that a drivcr or occupant poses an imminent dangcr of dcalh or scrious physical injury
to the officer or others may fire at the driver or an occupant only when such shots are
necessary to avoid death or serious physical injury to the officer or another, and only if the
public safety benefits of using such force reasonably appear to outweigh any risks to the
officer or the public. Except in rare circumstances, the danger permitting the officer to use
deadly force must be by means other than the vehicle.

(2) WEAPONS MAY NOT BE FIRED SOLELY TO DISABLE A MOYING

VEHICLE.

(3) Weapons may be fired at the m:h:tt.or other occupant of a movine vehic:!e
only when:

(a) The officer has a reasonable belief that the subject poses an imminent danger of
death or serieus,physical injury to the officer or another.

f:-. IGlOUSiANIMALS. Deadly force may be directed againstdogs or other vicious

animals when 'necesS8l:y in self - defense or defense of another, and the benefits ofsuch force
outweiglurthffrisn to the safety of the officer or other persons.

g. DEFINITIONS:

(I) Deadly force is the use of any force that is likely to cause death or serious
physical injury. When an officer of the Department uses sueh force, it may only be done
consistent with this policy. Force that is not likely to cause death or serious physical injury,
but unexpectedly results in-such harm or deat\.!, is not governed by this policy.

(2) Probable cayse. rcason to believe or a reasonable belie( for purposes of this
Training Unit, means facts-and circumstances, including the reasonable inferences drawn
therefrom,-known.to the officer at the time of the use of deadly force, that would cause a
reasonable officer to conclude that the point at issue is probably true. The reasonableness of a
belief ordecision must be viewed from the perspective of the officer on the scene, who may
often be forced to make split - second decisions in circumstances that are tense, unpredictable,
and rapidly evolving. Reasonableness. is not to be viewed from the calm v8!ltage point of
hindsight.
 267

l'Aln 11/

ROLE AND SPECIFICATIONS OF THE SEMIAUTOMATIC PISTOL.

HOLSTER AND AMMUNITION

I. Since the decision has been made to ann selected V A police personnel with a
semiautomatic fireann, it has been determined that a double action only system will be
utilized. This semiautomatic system only allows the weapon to be fired with a deliberate
stroke of the trigger mechanism. This type of system has been proven to be the easiest and
safest system for police personnel to operate and to be trained with. The double action only
semiautomatic system has been referred to a~ a revolver with a magazine. Each of the
selected persons will attend an approved firearm~ tran~itional pistol course of training to
ensure that they are completely familiar with the operation and safe weapons handling of the
selected handgun. All officers will be required to qualify on an approved course of fire with
the issued handgun and duty ammunition on a semiannual basis.

2. The authorized semiautomatic pistol for selected personnel must meet the following
criteria: It must be 9mm Luger caliber (9 x (9) semiautomatic pistol with double action
trigger mechanism only. The frame will consist of an aluminum alloy with steel slide. The
safety features must include a magazine disconnector, firing pin safety, and trigger weight
nine to eleven pounds set at the factory. NO MODIFICATIONS OR ALTERATIONS
ARE ALLOWED. such as" trigger shoes, extended slide stops, extended magazine release
and no after market extended magazines." The sights will consist of front and rear trijicon
night sights. :

3. The holster authorized by the Office of Security and Law Enforcement must be equipped
with a minimum of three safety features. The holster will be equipped with a thumb break
release, an internal safety feature, and a ten~ion release. The holster must be black in color
and constructed of high quality material. All uniform personnel will be issued dual magazine
carriers with Velcro closure and four (4) helt keeper~ of matching material. The holster
familiarization will consist of 200 draws in the presence of a firearms instructor.

The holster for plain clothes officers authorized by the Office of Security and Law
Enforcement must be equipped with a minimum of one safety feature, a thumb break retaining
device. The holster will be of a design to be carried for a strong side draw. The holster will
be equipped with a paddle type retainer, adjustable' retention screw and thumb break release.
The holster must be black in color and constnlcted of high quality material. All plain clothes
personnel will be issued a single magazine carrier with Velcro closure and belt clip.

4. Issued duty ammunition will be 9mm Luger caliber, 124 grain brass jacketed hollow point,
~.!lISTIIUTIONS...AllliA1J,O~Jo;-'). All qualitication cour.;es will he .fn-cd with
issued duty ammunition . Issued duty ammunition will hc cxpended cvery six (6) mOllth~
dminl\ rangc qualification and ncw duty al11n,"nilio'l will he issucd. The 9mm 1.lIger caliher,
full melal casc o 124 gtain cal'lridgcs lIIay II\" II ';,'" I,,, lraillillj', purposes only .
 268

I'ART IV

TRANSITIONAL PISTOL TRAINING

I. PHASES OF TRAINING: Transitional pistol training is divided into two phases:

Prepantory marksman.hip tnining and nnge firing. Each phase may be divided into
separate instructional steps. All marksmanship training must be continually progressive.
Once theoffacer becomes proficient in the fundamentals of marlcsmanship, the officer will
then progress to the advanced techniques of tactical marksmanship. Tactical marksmanship
techniques should only be practic:ed after the basic marksmanship skills have beenacquired.

2. FUNDAMENTALS:

a. The main use of the pistol is close range engagement oC lethal force encounters with
quick, accurate rue. In.shooting encounters, it is not the first round fired that wins the
encounter, but the first aec:untely fired round. Accurate shooting resuits from knowing and
correctly applying the clements of marksmanship. The elements of pistol marksmanship arc:

Grip
Aiming
Breath Control
Trigger Squeeze
'Targd~t
positions

b. Grip

(I) lbe handgun must become an extension of the hand and arm. It should replace
the index finger in pointing at any object or target. A firm, uniform grip must be applied and
acquired to the pistol grip. A proper grip is one of the most important fundamentals of rapid
or quick fire shooting.

(2) One - band Grip: Holding the handgun in the non firing hand; form a V with
the thumb and forefinger of the strong hand ( firing hand). Place the handglID in the V with
the front and rear sights in line with the firing arm. Wrap the lower three fingers around the
pistol grip, applying equal pressure with all three fingers to the rear. Allow the thumb of the
firing hand to rest alongside the handgun without .pressure. Grip the weapon tightly with
sufficient pressure to leave a light grip panel impression in the palm of the strong hand. At
this point, the necessary pressure for a proper grip has been established. Place the trigger
finger between the tip and second joint so that it can be sl\ueezed to the rear. The trigger
finger must work independently of the remaining lingers. NOTE: I f any of the three lingers
on the grip is relaxed, the grip must be reapplied .
 269

(3) Two - hand Grip: The two - hand grip allow~ the officer to steady the firing
hand and provides maximum support during deliberate or rapid fire shooting. The non - firing
hand becomes a support mechallism for the firing hand by wrapping the fingers of the non _
firing hand around the firing hand. Two - hand grips are recommended for all types of
handgun shooting.
WARNING

IF THE NON - FIRING THUMB IS PLACED TO THE REAR OF THE PISTOL THE
RECOIL FROM THE PISTOL SLIDE COULD CAUSE PERSONAL INJURy.

(a) Fist Grip: Grip the handgun as described in the paragraph above. Finnly close
the fingers of the conferring hand over the fingers of the firing hand, ensuring that the index
finger from the non - firing hand is between the middle finger of the firing hand and the
trigger guard. Place the non - firing thumb alongside or on top of the firing thumb. The index
finger of the support hand should be in contact with the bottom of the trigger guard. This grip
is commonly referred to as a clam shell.

(b) Palm Supported Grip: This grip is commonly referred to as the cup and saucer
grip. Place the non -faring hand under the firing hand, wrapping the non - firing fingers
around the back of the firing hand. Place the non - firing thumb over the middle finger of the
firing hand.

(c) Weaver Grip: Applied the same as the fist grip. The exception is that the non-
firing thumb is wrapped over the firing thumb. -.

(4) Isometric Tension: As you raise your arms to the firing position you apply
isometric tension. This is commonly know as the push - pull method for maintaining
weapon stability. Isometric tension is when you apply forward pressure with the firing hand
and pull rearward with the non -firing hand with equal pressure. This creates an isometric
force but never so much to cause the officer to tremble. This steadies the pistol and reduces
barrel rise from recoil. The supporting arm is be'rat with the elbow pulled downward. The
firing arm is fully extended with the elbow and wrist locked. The officer must experiment to
find the right amount of isometric tension to apply. Remember, the firing hand should exert
the same pressure as the non -firing hand . I f the pressure is not equal, a missed target could
result.

(5) Natural Point of Aim: The officer should check their pistol grip positioning for
the use of a natural point of aim . To accomplish thi~ check, grip the handgun and sight
properly on a distant target. Whilc maintaining the grip and stance, close your eyes for three
to five seconds. Open your eycs and check for proper sight picture. If the point of aim is
disturbed, make the adjustments to your stance to compensate. If the sight alignment i~
disturbed. you adjust the grip to compensate by removing the handgun from tlie firing hand
and reapplying the grip, The officer will repeat this process until the sight alignment and
sight placement remain alru(lst the sanll' when you oJlCn your eycs. This enables the officer tn
"<:lcrmine and usc a natur:1ll'uilll or aim ""C<' ~'''" have slIflicicmly pr"clicet! , This is the
mos t rda\l..'tI positiun for hnltlin ~'. and Ii, Hlp. 1111.: handgun
 270

c. Aiming

(I) Aiming is sight alignment and sight placement. Sight alignment is the centering
of the front blade in the rear sight notch. The top of the front sight is level with the top of the
rear sight and is in correct alignment with the eye. For correct sight alignment, you must
center the front sight in the rear sight. You will then raise or lower the top of the front sight
so it is level with the top of the rear sight. There should be an equal amount of light on both
sides of the front sight as you look through the rear sight. You will always introduce the
sights of the pistol into your line of sight. The front sight must remain perfectly clear.

(2) Sight placement is the positioning of the handgun's sights in relation to the target
as seen by you when you aim the handgun. A correct sight picture consists of correct sight
alignment with the front sight placed under the center mass of the target, commonly referred
to as a six o'clock hold. The eye can focus only on one object at a time at different distances.
Therefore the last focus of the eye is always on the front sight. When the front sight is seen
clearly, the rear sight and target will appear hazy. Correct sight alignment can only be
maintained through focusing on the front sight. The bullet will strike the target even if the
sight picture is partly off center but still remains on the target. Sight alignment is more
important thansighl placement. Since it is impossible to hold the handgun completely still,
you must apply trigger squeeze and maintain correct sight alignment while the handgun is
moving in and around the center of the target. This natural movement of the pistol is referred
to as the wobble area. The officer must strive to control the limits of the wobble area through
proper breath control, trigger squeeze, positioning and grip

(3) Sight alignment is essential for accuracy because of the short sight radius oflhe
handgun. For example, if a 1110 - inch error is made in aligning the front sight in the rear
sight, the officer's bullet will miss the point of aim by approximately 15 inches at a range of
25 yards. The 1110 - inch error in sight alignment magnifies as the range increases - - at 25
yards it is magnified approximately 150 times.

(4) Focusing on the front sight while applying proper trigger squeeze will help you
resist the urge to jerk the trigger and anticipate the actual moment the handgun will fire.
Mastery of trigger squeeze and sight alignment requires practice.

d. BREATH CONTROL: The officer must learn to hold their breaih properly at any
time during the breathing cycle if you wish to a;;ain accuracy that will serve you in violent
lethal encounter. This must be accomplished while aiming and squeezing the trigger. While
the procedure is simple, it requires eKplanation. demonstration, and supervised practice. To
hold the breath properly you take a breath. let it out, then inhale normally. let a little out until
comfortable, hold and then fire . It is diflicuh 10 maintain a steady position keeping the front
sight at a precise aiming poini while breathin!! . .... OU should be laughtto inhale, then eKhale
normally, and hold your breath at the mllmCIII " ; the niltuml respiratory paose. The shllt mllst
then be fired before you feel an)' discomfort frl'm nol breathing. When multiple targets are
presented, you must learn 10 holll your br~ath ~; :lIIy partu!' the breathing cycle. Ilreath
control musl be pmcliced during dry - lir~ excr< : ::~s ulllil it bCl'lllncs a natural pan ufthe
I'd,,!! prf)Cl~SS .
 271

e. Trigger Squeeze:

(I) Improper trigger squeeze causes more misses than any other step of preparatory
marksmanship. Poor shooting is caused by the aim being disturbed before the bullet leaves
the barrel of the handgun. This is usually the result of jerking the trigger or flinching. A
slight off center pressure of the trigger finger on the trigger can cause the handgun to move
and disturb the officer's sight alignment. Flinching is an automatic human reflex caused by
anticipating the recoil of the pistol. Jerking is an effort to fire the handgun at the precise time
the sights align with the target.

(2) Trigger squeeze is the independent movement of the trigger finger in applying
increasing pressure on the trigger straight to the rear, without disturbing the sight alignment
until the handgun fires. The trigger slack, or free play, is taken up first, and the squeeze is
continued steadily until the hammer falls . If the trigger is squeezed properly, you will not
know exactly when the hammer will fall; therefore, you do not tend to flinch or heel, resulting
in a bad shot.

(3) To apply correct trigger squeeze, the trigger finger should contact the trigger
between the tip of the finger to the second joint ( without touching the pistol anywhere else).
Where contact is made depends on the length of your trigger finger. If pressure from the
trigger fmger is applied to the right side of the trigger or pistol, the strike of the bullet will be
to the left nus is due to the normal hinge action of the fingers. When the fingers on the right
hand are closed, as in gripping, they binge or pivot to the left, thereby applying pressure
straight to the left. (If you are left handed, this action is to die right.) You must not apply
pressure left or right but increase finger pressure straight to the rear. Only the trigger finger
must perform this action. Dry - fire training improves straight to the rear without cramping or
increasing pressure on the hand grip.

(a) Officers who are good shooters hold the sights of the handgun as nearly on the
target center as possible and continue to SqUCC7.e the trigger with increasing pressure until the
weapon fires.

(b) Officers who are bad shooters, try to .. catch their target" as their $ight alignment
moves past the target and fires the pistol at that instant. This is called ImbJ!bjng, which
causes trigger jerk.

(4) Follow through is the continued effon in maintaining sight alignment before,
during and after the round has becn fired . Relea~ing the trigger too soon after the round has
been fired results in an uncontrolled shot, c;lUsing a missed target.

f. Target Engagement:

(I) To engage a single target, YOIl apply the method previously discussed. When
multiple perpetrators are engaged, the (;..I.JJSJ~~: and MOST I>ANGEI!OUS individual is
engaged lirst and should be fire,1 at with a minimulII .. rthree shots. You then traverse and
,,,
aC(luire the.: next larget. Hligl1ill'~ Ihe si!~hl : ; ill Ih ("'.- nler of mass. If.cusing on rlu.' frnlll si!-!,ht .
 272

apply trigger squeeze and fire. You must ensure your firing arm elbow and wrist are lockcd
during all engagements. If you missed the first target and have fired upon the second target,
index back to the first target and engage il. Some problems in target engagement are as
follows:

Indexing targets too fast

Moving the handgun before the head
Recoil anticipation
Trigger jerk
Heeling

(2) Indexing too rast. This occurswhen the operator is' moving the pistol faster than
the head and eyes are unable to keep the' front sight focused . This is observed as a quick
panning motion with the handgun.

(3) Moving the handgun before the head. It is important when engaging mUltiple
perpetrators to move the head first, then move the handgun, attain sight aligrunent, and trigger
squeeze to complete the firing sequence. Move the head first to visually make target
acquisition, sight alignment, ud then trigger squeeze.

(4) Receil anticipation. When you firstJearn to shoot, you may begin to anticipate
recoil . .This reaction-may'causeyou.to tighten your muscles during or just before the Iwnmer
falls. You may fight the recoil by pushing the handgun downward in anticipating or reacting
to its firing. You may lift the handgun upward in anticipating or reacting to its firing. In
cithcr case, the rounds will not strike the point of aim.

(5) Trigger jerk. This occurs when you see that you have acquired a good sight
picture at center mass and "snap" off a round before the good sight picture is 1051. This may
becomc a problem, especially whcn you are learning to usc a nash sight picture. This is a
quick snapping motion of the trigger finger.

(6) Heeling. This condition is caused by tightening the large muscle in the heel of the
hand to keep from jerking the trigger. Officers having problems with jerking the trigger try to
correct the fault by tightening the bottom of the hand, which results in a heel1!d shol. Heeling
causes the strike of the bullet to hit high on the firing hand side of the target. officers can
correct shooting error by knowing and applying correct trigger squeeze.

g. Positions:

(I) A qualification course is fired from the standing. kneeling, crouch and prone
positions. All of the firing positions described must be practiced so they become natural
movements. during qualification and tactical firin!,!. Though these positions seem natural.
practice sessions must be conducted to ensure the habitual attainment of correct firing
IXlsitions. You must he ahlc to assume currect firin!! positions quickly without any conscious
effort. I'i stnlmarksmanshil' requires you to ral'idlv al'llly all the. fundamcntals ilt d<lIlgerously

I!
 273

close targets while under high leyels of stress. A,;sullling a proper position to allow for a
steady aim is critical to your survival.

Standing without support

Standing with support
KJleeling without support
KJleeling with support
Crouch
Prone

(2) Standing without support. Face the target. Place the feet a comfortable distance
apart, approximately shoulder width apart. Extend the firing ann and attain a two - handed
grip. The wri~t and elbow of the firing ann are locked and pointed towards the target center.
Keep the body straight with the shoulders slightly forward of the buttocks, and the knees
should be slightly bent or unlocked.

(3) Standing with IUpport. Using available hard cover for support - - for example, a
tree or wall to stand behind. Standing behind a barricade with the firing side on line with the
edge of the barricade. There are two methods to attain this position. (a) Place the wrist or
back of the non - firing band at eye level against the edge of the barricade. Introduce the
firing hand to the non - firing hand to attain a two - hand grip to assume the firing position.
Lock the elbow and wrist of the firing ann. Move the foot on the non - firing side forward
until the toe of the boot touches the bottom of the barricade. (b) Place the knuckles of the
non - firing hand at eye level against the edge of the barricade. Introduce the firing hand to
the non - firing hand to attain a two - handed grip to assume the firing position. Lock the
elbow and wrist of the firing arm. Move the foot on the non- firing side forward until the toe
of the boot touches the bottom of the barricade. Caution must be used in this position, if too
much pressure is applied to the knuckles of the non - ftring hand against the barricade, injury
may occur during the firing sequence.

(4) Kneeling without support. In the kneeling position, ground on the firing side
knee as the main support. Vertically place the foot, used as the main support, under the
buttocks. Rest the body weight on the heel and toes. Rest the non - firing arm just above the
elbow on the knee not used as the main body support. Use the two handed grip for firing.
Extend the firing amI, lock the firing amI elhow ami \nist to ensure solid ann control. An
alternative to this position: Ground hoth knees and placing the buttoc~s on the heels of the
feet. The officer rocks back gently and then allains a two - handed grip for firin!! . Extend the
firing ann, lock the firing ann elhow and wrist to ensurc solid arm control.

(5) Kneeling with support. Usinl,( available hard cover for support -- for example. a
low wall, tree, or vehicle. I'lace the tiring side kncc on the ground. Bend the olhcr knee and
place the non - firing foot nat on the ground. pointing toward the targct. Extcnd arms
alongside and hrace them a~ainst ;"'ailahlc cover. I.ock thc wrist and elhow ()r the tirinl,( ann.
Place the mill - liring hatKI around the tistt" Stlpp"rt the tirillg arm. Rcstthe 11'\11 - tirin~ arlll
iust ahove Ihe elhow nn the nOll - lirin,! s ick- bH: ,: t " Hltac i with Ihe harricade may he
 274

establis\led with the non firing wrist, back of hand, or forearm once.a firing position has
been auained.

(6) Crouch. Use the crouch position when surprise targets are engaged at close
range. Place the body in a forward crouch (Boxer'S Stance) with the knees bent slightly and
trunk bent forward from the hips to give faster recovery from recoil. This is NOT an
EXAGGERATED CROUCH or DEEP CROUCH position. Plaee the feet naturally in a
position that allows another step toward the target. Extend the handgun straight toward the
target, and lock the wrist and elbow of the firing arm. It is important to consistently train with
this position, since the body will automatically crouch under high levels of stress. This .
position is also faster to change direction of fire .

(7) Prone.. Lie flat on the ground, facing the target. Extend the firing arm towards
the target with the ann locked. bring the non firing hand in a support position underneath
the firing hand on the ground. Bend the left knee up slightly below waist level. Push with the
left knee and foot rolling the body towards the firing side. The head is kept in a straight line
with the handgun and the strong side cheek will make contact with the firing ann bicep. Keep
the firing aim and wrist locked for the firing sequence. This position is a modified prone rifle
position. The alternative is to lie flat on the ground, facing the target. Extend the arms
directly in front with the firing ann locked. The arms may have to be bent slightly. unlocked
for firing at high targets. Rest the butt of the handgun on the ground for single, well aimed
shots. Wrap the non - firing hand fingers around the rangers of the firing hand. Face Forward.
Keep the head down between the arms IS much IS possible and behind the weapon.

! ~
 275

I~ART V

OPERATION

Part V. (Operation) will provide guidance and direction in the loading of the Department
approved firearms.

I. Initial loading with the slide locked to tbe rear: This method has the advantage of
allowing the officer to check the handgun visually and physically by looking down the
magazine well and feeling the firing chamber to ensure that the weapon is ready to receive
ammunition. The steps for this procedure are as follows:

a. Point the muzzle of the handgun in a safe direction.

b. Keep the finger out of the trigger guard and off the trigger.

c. Pull the slide to the rear and push up on the slide stop to lock the slide back. This is
best accomplished by using the "push-pull" method. PUSH forward with the strong hand
holding the weapon, while PULLING the slide to the rear with the weak hand.

d. Visually and physically check the magazine well and firing chamber to ensure the
weapon is ready to receive ammunition.

e. Insert a fully loaded magazine into the weapon and tug on the floor plate to ensure
the magazine is fully seated.

f. Allow the slide to go forward by:

(\) Depressing the slide stop, allowing the slide to go forward and chambering a
round. This should be accomplished with the thumb of the weak hand. This allows a two
hand control advantage as the weapon may seem to "leap" out of the hand.

(2) Grasping the rear grasping grooves or the slide with the weak hand and pulling the
slide back, releasing the slide and allowing the slide to "sling shot" forward,-chambering the
round .

NOTE: Do not allow the weak hand to "ride" the slide forward. A malfunction
may occur if the weak hand "rides" the slide fOI'ward while chambering a round.

g. Holslcr the handgun and engage all security devices.

h. The loading sequence is now compleled .

2. l"iti:tII .. :"lill~ wilh thl' slid" f",wa..,l: '1his proced"re may he prefemhle if the officer is
leli handed. or having Imuhle lockinl'. Ih" slitle' I" Ih" rcar. or whcn wearing gloves. The sleps
arc as follows:
! I
 276

(af Point the muzzle of the handgun in a safe direction!

(b) Keep the linger outside of the trigger guard and off the trigger.

(c) Insert a loaded magazine and tug on the floor plate to ensure tile magazine is fully
seated.. .

(d) Pull the slide to the rear with .the weak hand and then release the slide to allow it
to "sling shot" forward to chamber a round. Be careful not to ease or allow the weak hand to
ride the slide forward, as this may cause the slide to NOT go into battery resulting in a
malfunction.

(e) Holster the handgun and secure all security devices.

NOTE: Officers will receive 3 loaded magazines when they receive their issued fireann for
their assigned tour of duty. There will not be any loose ammunition issued in addition to the 3
loaded magiwnes.

3. UNLOADING: Unloading is performed as carefully as possible with no time limits and

under no s.tress. Many accidents occur due to improper unloading procedures. Unloading
should be performed as follows:

(a> Keep the muzzle of the handgun pointed in a safe direction.

(b) Remove the finger from the trigger guard and off the trigger.

(c) Remove the magazine and place the magazine in a pocket or in the belt line.

(d) Using the push - pull method, grasp the rear grasping grooves of the slide and rack
the slide back with sufficient force to eject any live round from.the chamber. The officer
should visUally observe the round in the firing chamber eject. Raclt the slide back several
times. NOTE: Neyer place YOur hand over the ejection port if there is a round in the lirioe
cbamber and oeyer attempt to catch ao ejectioe round Comoe the ejection port with the
hand could allow the round to fall back ioto the ejectioo port. causioe the ejector to strike the
primer oCthe cartridge dc1!mating in yOllt.hirul. At this point the handgunshould be
unloaded.

(e) Grasp the slide and lock it to the rear position.

(f) Visually and physically inspect the pistol to cn~urc it is unloaded.

NOTE: IF TilE OFFICER liAS ANY nOUnT TIIAT THE FIREARM IS LOADED,
R ..:PEAT TilE UNLOADING I'IU)( :EnUltElINTII. SATISFIE)) TIIAT TilE
FmEARM IS lJNLOAI)EJ).
 ~7

4. Technique of proper gripand draw: T he initial draw is designed to familiarize the

officer with the location of the holstered pistol and proper grip technique.

(a) Begin with the strong hand extended, palm down, elbow bent, locating the holster
or pistol grip with the elbow.

(b) Swing the strong hand directly to the grip of the handgun, establishing a strong
hand grip on the handgun. The strong hand should have acquired a firing position on the grip.

(c) After the strong hand grip is established, the strong side thumb locates the thumb
break safety device and is prepared to unsnap the device for the draw. The strong hand should
now be properly positioned for the draw.

(d) Releasing the thumb break safety device, draw the handgun Straight up. As soon
as the handgun clears the top of the holster, the weak hand seeks out the firing hand and a two
handed firing grip is established. Keep the firing hand trigger finger out of the trigger guard
and ofT the trigger. Point the muzzle forward while raising the handgun to eye level and lock
the firing hand wriSt. NOTE: The weak hand should be moving towards the strong hand
immediately at the onset of the draw. Both hands should be at a belt level position from the
onset of the draw. .

(e) The head should move as little as possible during this process.

5. Malfunctions - Primary method oflmmediate Action iTap, Raek, Assess.

a. TAP! The bottom of the magazine with the palm of the weak hand to ensure it is
fully sealed. 'nlis is a sharp blow 10 the floor plale of the maga7jne.

b. RACK! The slide with sufficient force to clear any defective round in the firing
chamber, stove piped casing, and to also chamber anew round in the firing chamber.

c . ASSESS! Bring the handgun back up to a firing position and fue if an appropriate
target is present and circumstances still call for shots to be fired .

NOTE: The above described procedure will clear nlost malfunctions that occur in the
use of a semiautomatic pistol.

6. Secondary method oflmmediate Action. UOllbleFeed.

a. RIP! Rip or remove the magazine from the handgun to clear a double feed or
defective magazine from the handgun . llli s is accomplished by pulling on the f1~r plntc of
the magazine with the weak hand fingers to cxlr,!C1 lhc lI1aga7.ine. NOTE: mSCARD TillS
MAGA1JINI~, UO NOT ATrEMI'T TO SA n : TillS MA(;A1.1NR .

h . ''VOltK! Wnrk Ih" slill" ICllh,' ,,';0' t d ':i11 an y ,Iereclive round frollllhc firin v,
c hmnhc r a nd maga /.i nc \\'.:11. I .nc k the Slilk In . . . !,,"a r p. ,si.tinn .
,.
 278

c. TAl'! Tap or insert a fresh magazine, as the magazine may have been the source of
the malfunction. It is always preferable to have a fully loaded magazine in the handgun if
possible.

d. RACK! Rack the slide to the rear utilizing the sling shot method to chamber a
round in the firing chamber.

e. ASSESS! Fire at the target if appropriate.

7. Emergency Reload I Speed load: Emergency reload I Speed load are the tenns used
when you have expended all rounds in the magazine of the handgun and the slide is locked to
the rear. In a lethal force confrontation this constitutes an EMERGENCY. YOU MUST:

a. Recognize that the slide of the handgun has locked back to the rear.

b. Establish a grip with the weak hand on the fresh magazine.

c. Depress the magazine release with the strong hand while bringing the handgun to
the mid torso area and tilt the handgun slightly with the empty magazine well pointed towards
the body ready to receive the fresh magazine.

d. With the index finger of the weak hand along the front spline of the magazine,
insert the magazine into the magazine well with enough force to fully seat the magazine.

e . . Bring the handgun back up on target and allow the slide to go forward by:

(I) Depressing the slide stop with the thumb of the weak hand. (This is a common
method used by right handed persons).

(2) Grasping the rear grasping grooves of the slide with the weak hand and sling shot
the slide forward. (This is a common method used by left handed persons and those wearing
gloves). This method may also be preferred during high stress situations where finding the
small slide stop could be difficult.

(3) FIRE IF APPROPRIATE.

8. Tactical reload: This procedure is accomplished by dropping the magazine from the
pistol while a round is still in the chamber. This procedure should be exercised when you
know that you have lost count of the number of rounds that you have expended and you are
preparing to move from a covered position. You have the opportunity to reload, but may still
be in the threat zone. This procedure allows you the ability to speed up the loading time,
because you do not have tn manipulate the slide, and fully load the weapon again to capacity.
You should:

tI . Renton.! the IiI1!!cr front the tr1 ~ ', ~l'r :md l ril;!gcr guarcl while hringing the handgun to
the mid 11 )r sn :lh' a .
.."'
 279

b. Grasp a full magazine with the weak hand.

c. The weak hand with the fresh magazine approaches the noor plate of the maga7jne
that is in the handgun. Depress the magazine release with the thumb of the strong hand.
Catch the magazine that is in the handgun in the palm of the weak hand and then grasp the
extracted magazine between the third and fourth fingers.

d. With the index finger of the weak hand along the fl'9nt of the magazine spline,
insert the fresh magazine into the magazine well. Place the extracted magazine into a pocket
for future use if needed.

e. Bring the handgun back upon target and fire if appropriate.

f. This magazine exchange should be utilized from behind cover and prior to moving
from cover or at any point the officer loses count of rounds expended. ALWAYS MOVE
FROM COVER WITH A FULLY LOADED HANDGUN.

9. Tactical magazine exchange: Tactical magazine exchange procedure is the process of

exchanging magazines in the handgun to allow the officer to top off the handgun while saving
the partially loaded magazine for future use. This procedure is not as fast as the other
reloading procedures, and is best perfonned from behind hard cover. You should:

a. Use hard cover if available.

:
b. Remove the finger from the trigger guard and off the trigger.

c. Bring the pistol to the mid torso level and tilt the handgun magazine well towards
the body to be in position to receive the fresh magazine.

d. Remove the fresh magazine from the pouch with the weak hand and with the weak
hand index finger.along the front spline of the magazine.

e. Bring the magazine to the base of the grip and remove the magazille from the pistol
by depressing the magazine release and catching the partially loaded magazine in the weak
hand.

f. Rotatc thc cxtracted magazinc in the pistol hc\wccnthc lillia finger and ring finger
of the weak hand.

g. Insert the fresh magazine by rotatinlJ the old magazine down and the new magazine
into thc magazine well and lock the fresh lIl,wazinc intn place.

h. Thc maga7.ine fIlay he retained in "OI'.1r ha",t or .

l .',
 280

I. Place the partially loaded magazine in the waistband or pocket. DO NOT

HEPLACE TilE I'ARTIALLY LOAOEJ) MAGAZINF. INTO TIIF. MAGAZINF.
POUCH CARRIER.

j. The tactical magazine exchange is completed.

I')
 281

PARTYI

COURSE OF FIRE

I. The objective of fireann training is to develop V A police officers into safe and competent
firearms handlers. It is the officers responsibility to act in a mature manner and use common
sense in safe handling procedures with the firearm. The following safety standards and range
rules will be adhered to by all officers engaged in firearms training. Any item not clearly
understood should be brought to the attention of an instructor for further explanation.
Infractions of or disregard for fireann safety will not be tolerated and will be dealt with
promptly and firmly hy training staff personnel.

a. SMOKING ON THE RANGE IS PROHIBITED EXCEI'TIN:DESIGNATED

AREAS. OFFICERS THAT SMOKE WILL BE REQUIRED TO KEEP
DESIGNATED SMOKING AREAS NEAT AND ORDERLY.

b. SAFETY RULES AND REGULATIONS.

(\) ALL FIREARMS TRAINING WILL DE CONDUCTED IN THE STATIC

MODE UNTIL FURTHER NOTICE.

(2) ALL FIREARMS ARE TO BE UNLOADED WlULE ON THE RANGE

AND SECURED IN THE HOLSTER WITH ALL SAFETY DEVICES SECURED.
:
(3) NO HANDUNG OF FIREARMS BEHIND THE FIRING LINE UNLESS
DIRECTED TO BY THE RANGE MASTER OR TIlE FIREARM IS RECEIVING
MINOR REPAIRS.

(4) WHEN ON THE FIRING LINE: KEEP YOUR FINGER OFF THE
TRIGGER! DO NOT PLACE YOUR FINGER INSIDE THE TRIGGER GUARD
UNTIL YOU ARE POINTING THE FIREARM AT THE TARGET. THIS IS
ESPECIALLY IMPORTANT WHEN DRAWING THE FIREARM FROM THE
HOLSTER.

(5) WATCH 'THE MUZZLE. THE MrZZLE OF ALL FIREARMS WILL BE

POINTED DOWN RANGE AT ALL TIMES WHEN NOT HOLSTERED.

(6) EACH TIME A FIREARM IS HAt\OLEDFOR ANY 'PURPOSE, POINT

THE MUZZ.LE IN A SAFF. DIRECTION. OPEN THE ACTION AND MAKE AN
INSI'ECTION TO ~NSUIU: THAT THE FIREARM IS UNLOADED. NEVER TRUST
MEMORY AND CONSII>ER EVERY FIREARM AS LOADED UNTIL YOU HAVE
PROVEN OTHERWISE. NEVEIt TUltN II' on ACCEI'T A FIREARM UNLESS
TilE ACTION IS (WEN.

(7) CIIECI( TilE I'IHEAHM FOH'B . \It1t EI. OIlSTIUJCTIOi"S IU~ I'O\U:
1.0AIlIN(; . IIE :\VY .( ; IU:ASE IS CONSIIHIU':J) .. \N OIlSTRIICTION.
 282

(8) IlQ NOT LEA VE A LOAIlEI) FIREARM UNA TfENI)EI>.

UN HOLSTERED FIREARMS WILL IIA VE ACfIONS OPEN AT ALL TIMES
WHEN NOT BEING FIRED.

(9) AcrlONS OF ALL FIREARMS WILL BE OPEN WHEN BEING

TRANSPORTED TO AND FROM THE RANGE UNLESS HOLSTERED.

(\0) DO NOT HANDLE ANY FIREARMS ON THE FIRING LINE WHILE

THERE IS ANYONE DOWN RANGE.

(\\) NEVER SPEAK TO ANYONE ON THE FIRING LINE UNLESS YOU

ARE EXPERIENCING PROBLEMS; AND THEN RAISE YOUR NON FIRING
HAND AND KEEP THE FIREARM POINTED DOWN RAl~GE.

(12) IF YOU SHOULD BE SPOKEN TO WHILE ON THE FIRING LINE, DO

NOT TURN AROUND TO MAKE A REPLY.

(\3) NEVER SNAP OR PRACTICE DRY FIRING AT ANY TIME OR

ANYWHERE EXCEPT IN TilE PRF.8ENCE OF A QUALIFIED FIREARMS
INSTRUCTOR.

(14) DO NOT LOAD UNTIL THE COMMAND IS GIVEN. NEVER

ANTIr:IPATE THE RANGE COMMANDS.

(\5) HOLSTERED FIREARMS WILL HAVE AI,L SAFETY DEVICES

SECURED AT ALL TIMES EXCEPT WHILE IN THE PROCESS OF DRAWING
THE FIREARM.

(\6) IN THE EVENT THAT THE FIREARM IS ACCIDENTALLY DROPPED,

REPORT THIS TO THE INSTRUCTOR IMMEDIATELY, WHO WILL INSPECT
THE FIREARM TO INSURE IT WILL FUNCTION. DO NOT PICK THE FIREARM
UP, LET IT LIE AND NOTIFY AN INSTRUCTOR. FIREARMS THAT COME INTO
CONTAcr WITH THE GROUND DURING THE RUNNING OF A TACTICAL
COURSE WILL BE REPORTED IMMEDIATELY TO AN INSTRUcrOR FOR
INSPECTION.

(17) IF A CARTRIDGE FAILS TO FIRE, STOP THE AcrlON AND WAIT

UNTIL THAT STAGE OF FIRE IS COMPLETED, KEEPING THE MUZZLE
POINTED DOWN RANGE, THEN REPORT IT TO AN INSTRUCTOR BY RAISING
YOUR NON SHOOTING IIANI).

(18) NEVER "'IRE A SUCCEIWING SIIOT FOLLOWING TilE

MALFUNCTION OF A CARTIUI)(;E UNTIL TIn: BAIUtEL HAS mmN
I~ XAI\1INlm TO m:TEltl\lINF IF A \l1IU .ET IS LOI)(;lm IN Tm: BAIUU':L .
 283

PARTYI

COURSE OF FIRE

1. The objective of firearm training is to develop V A police officers into safe and competent
fireanns handlers. It is the officers responsibility to act in a mature manner and use common
sense in safe handling procedwes with the firearm. The following safety standards and range
rules will be adhered to by all officers engaged in firearms training. Any item not clearly
understood should be brought to the attention of an instructor for further explanation.
Infractions of or disregard for fJreann safety will not be tolerated and will be dealt with
promptly and firmly by training staff personnel.

a. SMOKING ON THE RANGE IS PROHIBITED EXCEPT IN DESIGNATED

AREAS. OFFICERS THAT SMOKE WILL BE REQUIRED TO KEEP
DESIGNATED SMOKING AREAS NEAT AND ORDERLY.

b. SAFETY RULES AND REGULATIONS.

(I) ALL FIREARMS TRAINING WILL BE CONDUCTED IN mE STATIC

MODE UNTIL FURTHER NOTICE.

(2) ALL FIREARMS ARE TO BE UNLOADED WlULE ON THE RANGE

AND SECURED IN THE HOLSTER WITH ALL SAFETY DEVICES SECURED.
:
(3) NO HANDLING OF FIREARMS BEHIND THE FIRING LINE UNLESS
DIRECTED TO BY THE RANGE MASTER OR TilE FIREARM IS RECEIVING
MINOR REPAIRS.

(4) WHEN ON THE FIRING LINE: KEEP YOUR FINGER OFF THE
TRIGGER! DO NOT PLACE YOUR FINGER INSIDE THE TRIGGER GUARD
UNTIL YOU ARE POINTING THE FIREARM AT THE TARGET. TIDS IS
ESPECIALLY IMPORTANT WHEN DRAWING THE FIREARM FROM THE
HOLSTER.

(5) WATCH THE MUZZLE. THE MUZZLE OF ALL FIREARMS WILL BE

POINTED DOWN RANGE AT ALL TIMES WHEN NOT HO~STERED.

(6) EACH TIME A FIREARM IS HANDLED FOR ANY PURPOSE, POINT

THE MUZZLE IN A SAFE DlRECnON. OI'EN THE ACTION AND MAKE AN
INSPECTION TO INSURE THAT TilE FmEARM IS UNLOADED. NEVER TRUST
MEMORY AND CONSIDER EVERY FIREARM AS LOADED UNTIL YOU HAVE
I'ROVEN OTHERWISE. NEVER TURN IN OR ACCEI'T A FIREARM UNLESS
THE ACTION IS orEN.

(7) CIIECJ{ TIlE FmEAltM "-Olt IIAIUtEL OnSTIUJCTlONS 1JI':FOltE

LOAI>IN(; . IIEAVY (;IU': A~m IS ('ONSIIlEIUm AN OIlSTIHiCTION.
 284

(8) DO NOT LEAVE A LOADED FIREARM UNATTENDED.

UNHOLSTERED FIREARMS WILL HAVE ACTIONS OPEN AT ALI. TIMF..8
WHEN NOT BEING FIRED.

(9) ACTIONS OF ALL FIREARMS WILL BE OPEN WHEN BEING

TRANSPORTED TO AND FROM THE RANGE UNLESS HOLSTERED.

(10) DO NOT HANDLE ANY FIREARMS ON.THE FIRING LINE WHILE

THERE IS ANYONE DOWN RANGE.

(II) NEVER SPEAK TO ANYONE ON THE FIRING LINE UNLESS YOU

ARE EXPERIENCING PROBLEMS; AND THEN RAISE YOUR NON FIRING
HAND AND KEEP THE FIREARM POINTED DOWN RAl~GE.

(12) IF YOU SHOULD BE SPOKEN TO WHILE ON THE FIRING LINE, DO

NOT TURN AROUND TO MAKE A REPLY.

(13}NEVER SNAP OR PRACTICE DRY FIRING AT ANY TIME OR

ANYWHERE EXCEPT IN THE PRESENCE OF A QUALIFIED FIREARMS
INSTRUCTOR.

(14) DO NOT hOAD UNTIL THE COMMAND IS GIVEN. NEVER

ANTICIPATE TIlE RANGE COMMANDS.

(15) HOLSTERED FIREARMS WILL HAVE ALL SAFETY DEVICES

SECURED AT ALL TIMES EXCEPT WHILE IN THE PROCESS OF DRAWING
THE FIREARM.

(16) IN TilE EVENT TIIAT THE FIREARM IS ACCIDENTALLY DROPPED,

REPORT THIS TO THE INSTRUCTOR IMMEDIATELY, WHO WILL INSPECT
THE FIREARM TO INSURE IT WILL FUNCTION. DO NOT PICK THE FIREARM
UP,LET IT LIE AND NOTIFY AN INSTRUCTOR. FIREARMS THAT COME INTO
CONTACT WITH THE GROUND DURING THE RUNNING OF A TACTICAL
COURSE WILL BE REPORTED IMMEDIATELY TO AN INSTRUCTOR FOR
INSPECTION.

(17) IF A CARTRIDGE FAILS TO FIRE, STOP THE ACTION AND WAIT

UNTIL THAT STAGE OF FIRE IS COMPLETED, KEEPING THE MUZZLE
POINTED DOWN RANGE, TIIEN REI'ORT IT TO AN INSTRUCTOR BY RAISING
YOUR NON SHOOTING HAND.

(18) NEVER FIRE A SUCCEEI>JNG SHOT FOLLOWING THE

MALFUNCTION OF A CARTIUDGE UNTIL THE DARREL HAS BEEN
I~XAMINEJ) TO IWTEHMINE II' A mll.LET IS LOJ)GE!) IN THE !lAlmEL.

:',
 285

(19) NEVER PROCEED TO TilE TARGET AREA WITHOUT THE

COMMAND OF THE RANGE OFFICER. ALL FIREARMS SHALL BE PLACED IN
HOLSTERS AND SECURED BEFORE LEAVING FROM THE FIRING LINE

(20) HEARING AND EYE PROTECTION WHILE ON THE RANGE IS

MANDATORY FOR ALL PERSONNEL.

(21) ANY INJURY SUSTAINED DURING FIREARMS TRAINING,

REGARDLESS. OF HOW MINOR THE INJURY, WILL BE REPORTED TO AN
INSTRUctOR IMMEDIATELY.

(22) ANYTIME ANY UNSAFE ACT IS OBSERVED WHICH ENDANGERS

SOMEONE, THE OFFICER HAS THE RESPONSIBILITY TO SHOUT, "CEASE
FIRE" AND IMMEDIATELY RAISE THE NON SHOOTING HAND.

(23) TALKING WILL BE KEPT TO A MINIMUM WHILE ON OR NEAR

THE FIRING LINE. EXERCISE COURTESY WHILE OTHER OFFICERS ARE
SHOOTING OR RECEIVING ADDITIONAL INSTRUCTION.

ALL SAFETY PRECAUTIONS MUST BE STRICTLY ADHERED TO.

ALWAYS USE EXTREME CAtrrION TO AVOID ACCIDENTS AND INJURIES.

IF YOU DO NOT UNDERSTAND ~HE INSTRUCTIONS, RAISE YOUR NON

SHOOTING HAND AND ASK THE INSTRUCTOR THE QUESTION.

2. Qualification Course of Fire: This course of fire is designed to lest the officer's ability
with a handgun used in a realistic fashion. Depending upon the magazine capacity of the
pistol, the officer will have to change magazines at different points in the course. It is the
officer's responsibility to change magazines at whatever point it becomes necessary.

a. Fifty (50) round Pistol Qualification Course.

This qualification course requires fifty (SO) rounds of fire. All shols will be 4lrecled to the
center mass area of the target

I. The officer will proceed to the twenty live (25) yard line wilh an unloaded and holstered
pistol and three (3) magazines loaded with live (5) rounds each. Two (2)magazines will be
secured in the double magazine pouch on the duty belt and one (I) magazine secured in a
jacket or trouser pocket The officer will be given the command 10 load the pistol. TIle
officer will then insert one (I) magazine loaded with fivc rounds into the magazine well and
then introduce a live round into the chamber (safe loading procedure). The officcr willthcn
holster a loaded weapon and secure all safe" dc\ices.

At the twenly livc (25) yard linc,len (10) r.. '''''' ~ will he expended wilh ~p..:n[\. n~
J.J.M.!T. This will he slrn,w I""",,"" shunli"l',,:.!i/.in ~ ' 110 .. Iwo 1o'"IlI,,,1 sla",li,,!,. ""sIIppon<:"
 286

position. This exercise is designed to familiarize lhe officer with the known distance of
twenty five (25) yards. Upon completion of firing, the officer will holster an unloaded and
safe weapon and engage all safety devices. These shots WILL NOT be counted for
qualification score. The line wi"1I then be made safe. The officer will then move downrange
on command to assess their respective target. These shots will be marked to identify them as
being fired from the twenty five (25) yard line.

The officer will then load three (3) magazines to eight (8) or fifteen (I S) rounds
depending on the magazine capacity of the pistol.

2. The officer will then move to the fifteen (15) yard line. The officer will have two (2)
fully loaded magazines secured in the magazine pouch and one fully loaded magazine secured
in a jacket or trouser pocket. On command the officer will insert one (I) fully loaded
magazine into the magazine well and then introduce a live roWlll into the chamber (safe
loading procedure). The officer will then holster a loaded weapon and secure all safety
devices.

At the fifteen (IS) yard line fifteen (IS) rounds will be expended with imposed time
limits. This will be strong handed shooting utilizing the two handed standing unsupported
position. On command the officer will:

a. Fire three roWlIls with a ten (10) second time liDlil The officer will then holster a
loaded weapon and secure all safety devices.

b. Fire three rounds with an eight (8) second time limit. The officer will then holster a
loaded weapon and secure all safety devices.

c . Fire three rounds with a six (6) second time limit. The officer will then execute a
Tactical magazine exchange, placing the replaced magazine into a weale side trouser or jacket
pocket. The officer will then holster a loaded weapon and secure all safety devices.

d . Fire three rounds with a six (6) second time limit. The officer will then holster a
loaded weapon and secure all safety devices. .

e . Fire three rounds with a six (6) second time limit. The officer wiit malee the
weapon safe and holster an empty and safe weapon . TIle officer will then engage all safety
devices. The officer will then teload all magazines to capacity.

3. The officer will then move to the seven (7) yard line. The officer will have two fully
loaded magazines secured in the magazine pouch and one magazine secured in a jacket or
trouser pocket. On command the officer will insert a fully loaded magazine into the magazine
well of the pistol and then introduce a livc round into thc chamber (safe loading procedure).
The officer will thcn holster a loaded weapon and engage all safety devices. .

I\llhe seven (7) yard Ii",' lili..n (I ~ \ rtlttl .. ls will he expended wilh imposed till1c limits
Irtllll the sta nding two I,,"ukd "n' "l'l'm''''' p.),;i:itln" ()n ctllllllland the officer will :
:~
 287

a. Fire three round~ with a nine (9) ~econd time limit. The offieer will then hol~ter a
loaded weapon and seeure all safety devices.

b. Fire three rounds with a six (6) second time limit. The officer will then holster a
loaded weapon and secure all safety devices

c. Fire three rounds with a four (4) second time limit. The officer will then execute a
speed reload magazine exchange. The officer will then assume a low two handed gun ready
position.

d. Fire three rounds with a four (4) second time limit. The officer will then assume a
low two handed gun ready position.

e. Fire three rounds with a four (4) second time limit. The officer will then make the
pistol safe and holster and engage all safety devices. On command the officer will then
retrieve any item on the ground that is needed. The officer will then reload two magazines
with five (5) rounds each. Two loaded magazines will then be seeured into the magazine
pouch and one magazine secured into a jaeket or trouser pocket.

4. The officer will then move to the five (5) yard line. The officer will have two (2) loaded
magazines secured in the magazine poueh and one (1) empty magazine secured in ajacket or
trouser pocket. On command the officer will then insert a loaded magazine into the magazine
well of the pistol and then introduce a live round into the chamber (safe loading procedure).
The officer will then holster a loaded weapon and secure all safety devices.

At the five (5) yard line, ten (I OJ rounds will be expended with a fifteen (15) second
time limit. All firing will be from the standing one handed only firing position. On command
the officer will:

a. Draw and fire five (5) rounds with the strong hand only. Execute a speed reload.
Transfer the pistol to the weak hand only and :

b. Fire five (5) rounds with the lHlLliJJJtruUmly. The officer will thel;l make the pistol
safe and holster. The officer will then engage all safety devices. Un comllland the officer will
retrieve all items from the ground that they may need.

5. The target that will be utilized over this course of fire will be th~ FBI Q target. Scoring
will be counted at 2.5 points per hit inside the Q outline and all hits outside the Q outline will
be counted as a miss or minus 2.5 points. All hits on the outline border will be counted as a
miss or minus 2 .5 points. Total possible score is one hundred (100) points.

(I) ' At the twenty five (25) yard line. ten (10) rounds will be expended with rfQ
TIME_Llj\1J.T. This will be strung hand shooting only from the standing two handed
position. This exercise is desi~l1ed to ""niliarize the nnicer with the known distance 01'25
yards. These shnts ~\liU .nul he t".ntlllh',1 ")I" qnaliti,'at;nll score .
 288

(2) At the fifteen (15) yard line, fifteen (15) rounds will be expended with imposed
time limits from a two banded standing unsupported position.

(a) Three (3) rounds fired with a ten (10) second time limit.

(b) Three (3) rounds fired with an eight (8) second limit.

(c) Three rounds fired with a six (6) second limit. Tactical magazine exchange.

(d) Three (3) rounds fired with a six (6) second limit.

(e) Three (3) rounds fired with a six (6) second limit.

(3) At the seven (7) yard line fifteen (15) rounds will be expended with imposed time
limits from the two handed standing unsupported position.

(a) Three (3) rounds fired with a nine (9) second time limit.

(b) Three (3) rounds fired with an six (6) second time limit.

(c) Three (3) rounds fired with a four (4) second time limit Speed reload of
~ne exchange.

(d) Three (3) rounds fired with a four (4) sec:ond time limit.

(e) Three (3) rounds fired with a four (4) second time limit.

(4) At the five (5) yard line ten (10) rounds will be expended with a fifteen (15)
second time limit

(a) five (5) rounds strong hand only

(b) five (5) rounds weak hand only

(5) The target that will be.utili7.ed over this course of fire will be ~ FBI Q target.
Scoring will be counted at 2.5 points per hit inside the Q outline and all hits outside the Q
outline will be counted as a miss or minus 2.5 points. Total possible score is 100 points.

3. The officer must score a minimum of 80% to successfully pass the Pistol Qualification
Course. If the officer fails to acbieve tbis standard, additional remedial training will be
required to correct the deficiencies and a date and time will be scheduled for requalification.
Ifthe officer fails a sccond time, the officer will not be certified and the matter will he
referred to the Chief of l'lllice and Security Services frn further action.
 289

PART VII

CARE AND MAINTENANCE

I. Maintenance.

a. Your weapon will require to be maintained on a monthly basis. 11ae officer should
field strip the assigned firearm a minimum of once every thirty days. 'fhe officer should not
attempt to disassemble the firearm beyond this point. The office should inspect the field .
stripped firearm for lubrication, damage, and (;Ieanliness. All damage should be reported to
an instfU(;tor or designated armorer for repairs.

b. The weapon will be deaned by field stripping the firearm down to basic '
components. The barrel ben and dwnber will be cleaned~y brushing theseueas with a
good powder removing solvatt and bore bnish~ This is acc:omplished by cleaning from the
or
firing chamber towards the muzzle. Wipe the areas dean with patdieS a swab. Using a
small brush dipped in solvent, remo~ alldeposits from aroUnd the bm:ch of the biurel, firin'g
chamber, extractor, and residue on the frame with a light brushing and solvent. .After deaning
the entire firearm use a doth to apply a light coating of high quality gun o,i1to all external
surfaces and wipe clean. Re-Iubericate the slide rails and lubrication points on the rec:eiver of
the pistol. After the initial (;Ieaning, there is usually some residue in the barrei that wOrks out
and becomes apparent within 24 - 48 hours. This may be removed with a bristle brush and a
light reapplication of powder removing Solvent after which the oil film should be re-
established on all surfaces.

2. Field Stripping.

a. Disassembly.

(I) Remove the nii\gazine by depressing the magazine release bullon and inspect and
dear the firing chamber. Allow the slide to travel forward. Place the magazine into a pocket.

(2) Place.the grip of the firearm into the strong hand.

(3) Take the weak hand with the palm pointed down and place the weak hand on top
of the slide. Place the index finger on the right side of the receiver fnime onto the take down
hullOO.

(4) With the weak hand index finger depress the take down bullon holding pressure on
the bullon.

(5) With the thumb on th(; left side of the lower rt.'Cciver, slowly rotate the take down
lever 10 Ihe down posilion.

(6) The "pper slill" as,;clllhly and harrel , hn"loI Ihen "'(1",' fnrwmll "n Ihe slide rails .
 290

(7) With the weak hand, slowly pull the slide assembly forward and off of the frame.

(8) The firearm is now in two pieces, the lower receiver and slide assembly.

(9) Pick up the slide assembly with the weak hand with the front sight pointed down
and place the slide assembly into the palm of the weak hand.

(10) You will observe a coil spring assembly with a metal rod ~ is inserted into an
assembly facing you.

(II) Capture the tension on the spring assembly by pressing forward on the base of the
guide rod pin. Maintain pressure on this assembly or the guide rod may be ejected and cause
injury. Lift out this assembly and set aside.

(12) With the slide assembly still in the palm ofthe weak hand, apply light forward
pressure directly on the banel assembly at the firing chamber. The barrel will tilt forward
slightly and then move forw8rd. Lift on the rear oCthe barrel assembly and remove from the
slide assembly. The firearm is now field $tripped.

(13) The officer should have four components: Lower receiver, slide assembly,
banel, and the guide rod and coil spiing.

NO FURTHER DISASSEMBLY IS RECOMMENDED.

b. Reassembly:

(I) Place the slide in the palm of the weak hand with the rear of the slide facing your
body. The front sight is pointed toward the noor.

(2) Replace the barrel assembly into the slide assembly. Make sure the barrel is
seated properl y .

(3) Insert the guide rod into the coil spring housing.

(4) Insert the coil spring and guide rod into the spring guide assembly.

(5) Hold pressure against the base of the guide rod and push it forward enough to
engage the small radial machine cut in the barrel lug. 8e canful that it docs not become
disengaged, ny out and cause injury.

(6) Pick up the lower receiver with the strong hand and rotate the frame where the
magazine well is pointed up.

(7) Align the slide rails with the slide :I,"cmhly rail slots at the rear of the slide .

.'7
 291

(8) Move the rear of the slide onto the front slide rails and continue to move the; slide
towards the rear of the ~iver.

(9) As the slide moves past the lake down assembly you will hear an audible cliek.

(10) Depress the take down assembly button and rolate the take down lever to the up
position.

(II) .CbeCk on reassembly by working the slide several times and then lock the slide to
the rear.

(12) Reload IIId holsCer the firearm, securing all security devices.
 292

PART VIII

SHOOTING REVIEW TEAM PROCEDURES

I. Background'

a . .An administrative review will be conducted by the Office of Security and Law
Enforcement (OSLE) of incidents involving firearm discharges at or by V A police (not
including training).

b. The issues addressed during the shooting incident review relate to those facts which
may have directly or indirectly contributed to the shooting incident The issued handgun will
be collected into evidence in the event the action resulted in a fatality or serious physical .
injury. 'Ille invol ved officer wil!" be immediately issued a service pistol upon collection of the
firearm into evidence.

2.~:

a. Upon notification of a shooting incident, the Office of Security and Law

Enforcement (OSLE) will activate a shooting incident review team composed of those
appointed to conduct a thorough administrative review of the matter.

b. If matters relating to possible police officer misconduct surface, the OSLE will be
notified of the circumstances immediately.

3. Investigation: The shooting incident review will include but will not be limited to the
determination of the facts and circumstances related to the incident. At the conclusion of the
review, the members of the shooting incident review team will confer with the Office of
Security and Law Enforcement (OSLE) to report their findings, conclusions, and
recommendations .

4. ~: The shooting incident review team will report the facts and circumstances of the
review in writing to the DAS as soon as the inVestigation i~ completed. This does not
preclude the requirement for immediate reporting of the incident and periodic updates. Each
of the following areas will be addressed: '

a. A synopsis of the case and circumstances which existed prior to the incident.

b. Synopsis of events of the incident, specifically addressing the following areas:

(I) Identification, assignment, and position~ of all persons present during the incident,
tn include personnel, other law enforcclllt'nt personnel, witlll'S~\'S , ami sll'pcets.

(2) Suspect identification, 10 inclllde name, dale of hirth. home :.ddress, criminal
record, repulation. IlCntliug. crimin;.tl charges. ami arrest status.
 293

(3) Description and identification of all involved fireann(s) and expended ammunition
and identity of possessor at the time of the incident.

(4) Description of verbal warnings given to the suspect.

(5) A chronology of the first and succ:essive rounds.

(6) Identification and date of involved officer's current firearms qualification.

(7) The basis for the decision that the use of deadly force was required.

(8) . Identification of al\ injured persons, to include cause and extent of injuries, and
medical trcatment.

(~ Identification of all properly damage, to include cause, value of damage, and

responsible party.

(10) The date arid time of notification to the OS&LE.

c. Any unique factoru:ontributing to the incident (e.g. weather, equipment,

communications, misinformation, tactics).

d. Recommendations as to:

(\) Procedural or policy changes as outlined in V A orders or memoranda.

(2) Training requirements.

(3) Safety issues.

c . Attachments to the report:

(I) Copies of all statements and reports of interview.

(2) Copies of all official reports from investigating agencies.

(3) A schematic of the shooting scene, depicting the distances of all shooting
participants from the suspect(s).

(4) Photographs, as requircd.

5. MmitJis1rl!li2n:

a. Upon rcvicw of the shooting incident wrillcn report, the OS&LE lIlay mandate an
additional investig,ation. The OS&I .E lIlay als" "slahlish a t:ollllllill<..'C to furthcr study the
 294

incident and/or make additional inquiry or action based on the recommendations of the
shooting incident review team. .
b. Upon acceptance of the written report, the OS&LE will provide a copy of the
report, to the affected Chief, Police & Security Service.
 295

PART IX

POST SHOOTING PROCEDURES

I. Rcportin& Requirements (Firearm Disc;hanlc) The discharge of any fireann, (except in

training) either intentional or accidental by a V A police officer in conjunction with V A law
enforcemcnt activities requires reporting a~ follow~:

a. involved Police Officer The officer will immediately report the incident to their
supervisor. Such supervisor shall immediately report the facts and circumstances of the
shooting incident to the Chief, Police & Security Service.

b. Chief, Police & Security Servicc shall immediately report the facts and
circumstances of the shooting incident to the Office of Security and Law Enforcement
Inspector assigned to their region, and to the V A Law Enforcement Training Center (LETC) ,
North Little' Rock , AR. As soon as practicable, the Chief shall transmit a written report of
the incident to the Office of Security and Law Enforcement and to the V A LETC in North
Little Rock, AR.

2. R~n$ibilitics (Post - Sbgotin& Incident). It is the respoosibilily of all Police and

SecuritY Service employees to sbow sound judgment during and after an incident in which a
firearm was discharged. The following information is transmitted to ensure appropriate
reaction and follow up to a shooting incident.

a. Determine the physical condition of any injured person and render first aid where
appropriate. Request emergency medical aid, as appropriate, and notify local law
enforcement authorities of the incident and location.

b.- Liaison with other agencies with investigative jurisdiction in the incident should be
quickly established to prevent duplication of effort and conflict of jurisdiction. It is V A
police officer's duty and responsibility to cooperate with any lead investigative agency,
making witnesses and evidence available.

c. Shoul4the involved officer' s firearm be secured for evidentiary purposes or

ballistics exami~ation, another weapon will be issued to the officer, unless there is cause to
the contrary.

d. A VA police officer involved in a shooting incident should be encouraged to

contact their spouse or family as ~oon as possiblc. I r thc officer has becn injured. and so
requests, the officer's family will be contacted in person by a designated officer. In the case
of seriously injured officer, notification or the family should be done immediately and in
person. Thc officers on duty will also bc notified or the injured officer's condilion, in order to
provide an accurate response to l:lIl1ily members seeking inrormation. It is important that
':'lni1y notUicatintl occur hefore press "1ll1 Of Illl"tii" acc()unfS appear.
 296

e. The scene of the shooting incident should be processed for evidentiary purposes.
Evidence from the scene should include:

(I) A diagram showing the location of each officer and the location where each shot
wasfued.

(2) Photographs showing the involved officer', field of view at the time of the firearm
discharge.

(3) Photographs showing the location of any shooting victim(s).

(4) Evidence gathered, including blood, spent cartridges, weapons, and fingerprints.

(5) All involved fireanns should be examined for ballistic comparison with any
recovered bullets. An inventory should be maintained pertaining to the fireanns' possessor,
fireann description, type of ammunition, and number of spent rounds.

(6) The general area of the scene canvassed for witnesses. Witnesses to the shooting
incident should be encouraged to submit written statements.

(7) Copies of rqJOIts fiom all involved lawenfon:ement or emergency department

personnel.

(8) Copies of all telecommunications tapes pertainin~ to the initial call to emergency
personnel, etc., if any.

(9) Copies orall hospital, autopsy, laboratory, and photographic records.

3. Post - Shootin& Reactions:

a. There is a wide variation of reactions to shooting incidents. ReSearch indicates that

the majority of law enforcement officers involved in shootings experience moderate to severe
trauma reactions.

b. Officers either directly or indirectly involved in a shooting incident are referred to

the V A Employee Counseling Service.
 29'1

REFERENCt;S

Combat TRipi. with Pistols and Rcyolvers FM 23 -35. HeadqJ!lrtel's

Department of the Army Waabi0aton DC 1988

FBI Double AqioP Pjldgl Course. Federal Bureau oflnvestigation, U.S.

Department of Justice, Quantico. VA
_Safety lnstruc:tion& PIu1s Manual For Centerfire Pistols Double Action Only.
Beretta U. S. A. 17601 Beretta Drive, Accokeek. MD 20607
 298

FACILITY IMPLEMENTATION PLAN

I. The purpose of this Facility Implementation Plan is to describe authorized and prohibited
uses of the issued fireann by V A police officers. All V A police officers will adhere to
fireanns procedures and guidelines outlined by the Office of Security and Law Enforcement.

2. Since the decision has been made to arm selected V A Police personnel with a
semiautomatic fireann, it has been determined that a double action only system will be
utilized. The authorized semiautomatic pistol must be 9mm Luger caliber, with double action
trigger mechanism only. The frame will consist of a light alloy with steel slide. The safety
features must include a magazine disconnector, firing pin safety devices, and trigger weight of
nine to eleven pounds set at the factory . NO MODIFICATIONS OR ALTERATIONS
ARE ALLOWED. such as "trigger shoes, extended slide stops, extended magazine release,
no after market extended magazines, or grip adapters." The sights will consist of front and
rear Trijicon night sights.

3. The holster authorized by the Office of Security and Law Enforcement must be equipped
with a minimum of three safety features. The holster will be equipped with a thumb break
release, an internal safety feature, and a tension release. The holster musts be black in color
and constructed of high quality material. All personnel will be issued dual magazine carriers
equipped with Velcro closure and four (4) belt keepers of matching material. Holster
familiarization will consist of 200 draws in the presence of a firearms instructor.

4. Issued duty ammunition will be 9mrn Luger caliber, 124 tr;ain, brass jacketed hollow
point, NO SUBSTITUTIONS ARE ALLOWED. Training ammunition will be 9mm Luger
caliber full metal case 124 grain. All qualification courses will be fired with issued duty
ammunition. Issued duty ammunition will be expended every six (6) months during range
qualification and new duty ammunition will he issued.

5. A Pistol Qualification Course conducted on a semiannual (6 month) ba~is will consist of

50 rounds of duty ammunition. The course of fire is designed to test the officer's proficiency
with the issued pistol. A minimum score 0[80% is required to successfully pass the Pistol
Qualification Course. Additional remedial training will be given within 30 days to officers
failing to achieve this standard and a date nnd time will be scheduled for retuting. Officers
failing a second attempt will not be certified and the mattcr will he referred to the Chief.
Police and Security Services for further action.

6. Officers will he armed only while performing official duties and activities. Arnled
assignments will includc vehicle. foot. hic\"de aad K - 9 patrol and while stationed at
magnetometers and other fixed posts.

7. The firennn will not be worn off V A P'''l'crt\ ex,,",!pt whcnthe officer is transportilll\
prisoncr(s). while in route In another V A L,cili \:- nr in the performance of any nfficial
capacity tksi!!natcd hy till: ( :hicf. Police allt Sl.. I!nt~ Sl'I"\'il'C .
 299

8. Only those officers who have successfully completed their physical examinations within
the past 12 months and have newly completed psychological usessments will be armed.
Questions which are designed to determine an officer's suitability to be issued a firann. will
be included in the psychological assessment interview. Anned officers must maintain current
physical examinations and psy!lhological assessments.

9. A police officer's authority to QI'l')' a firarm will be suspended by the Office of Security
and Law Enforcement at any time evidence is receiwd or deYeIoped which would cause a
reasonable person to conclude thIl this authority should be revoked. 1be officer's authority to
carry the firearm will remain suspended tmtil the matter has been promptly and thoroughly
'or
investigated by the facility and
successfully adjudicated.
the Office of Security and Law Enforcement and
 300

CHECKLIST

I. STORAGE: Each facility will be required to provide an approved storage area for
firearms and related equipment.

ALL FIREARMS WILL BE SECURED IN A LOCKED FIREPROOF SAFE I vAULT

WHEN NOT ISSUED FOR DillY USE. The Chief, Police and Security Services will
determine the appropriate location for this area.

ITEMS TO BE MAINTAINED IN THE SAFE I VAULT:

A. All firearms for duty issue

B. All pistol magazines
C. Pistol storage rack(s)
D. All duty and training anununition
E. Weapons Log
F. Dehumidifying material or device
G. Magazine storage box

Cleaning equipment may also be stored in appropriate containers in the safe I vault. These
items may be stored in a separate container and may include the following items:

a. Commercial cleaning solvent in a sealed container

b. Commercial lubricating oil or synthetic lubricant
c. Cleaning rods appropriate size and lengths
d. Cleaning patches
e. Appropriate size cleaning bore mops
f. Appropriate size cleaning bronze or steel bore brushes
g. Medium size common screwdriver
h. Toothbrush style wire brush

2. ISSUANCE I RETURN OF ISSUED DUTY FIREARMS AND AMMUNITION:

Officers may only carry the Agency issued firearm and approved issued ammunition.
Firearms will be issued only by a designated officer by the Chief, Police and Security
Services. Each officer would be issued their assigned firearm, magazines, and appropriate
ammunition at the beginning of each tour of duty. It would be the Officer's ~esponsibility to
examine the firearm serial number to ensure that they have received the properly assigned
weapon. The officer then would initial off on a daily weapons log. At the completion of the
Officer's tour of duty, the officer would return to the issue point and return the firearm,
magazines, and appropriate ammunition. The officer would then complete the daily weapons
log. The firearm, magazines, and appropriate ammunition would then be placed into storage.
 301

3. CLEANING AREA:
The Chief, Police and Security Service would designate a cleaning area location for
maintaining proper maintenanc:e of fimmns. This area would .be well ventilated and well
lighted. This would be a NO SMOKING AREA. A small table may be appropriate in this
area.

4, TRAINING PLANS:

All firearms training plans mut be reviewed aild approved prior to any implementation or any
modifications of existinltfirearms training plans by the Officer of5ecurity and Law
Enforcement.

5. ARMORER'S REPOIQ'S.

Agenqr issued fuarms will be kept in a clean and serviceable condition. Issuefireanns will
be subject to inspection without notice by the Chief, Police and Security Service, fireanns
instructor or armorer. All agency issued firearms must be annually inspected and detailed
cleaned by a designated certified armor. This inspection is independent of the normal field
stripping mailltenance that the mamifacturer may suggest. It will be the armorer's
responsibility to maintain detailed records on each firearm that is issued for duty usc. Officers
wiltnot.1 JIlIb any mOdifications; repairs, or adjustments to Agency issued firearms. Agency
IDI10ren will make lilly repairs or adjustments they are qualified to make. Other repairs will
be referred to a mIUlUfacturer authorized repair center.

6 . .MALFUNCTION REPORTS .

It will be the responsibility of the designated firearms instructor or armorer to maintain

detailed records on agency issued farearms in the event an officer experiences a misfire,
malfunction or sustains damage to lilly agency issued firearm . The effected officer will notify
the designated atmorer as soon as possible once the problem is diagnosed. The firearm
instructor or annorer will "SUbmit a written report to the Chief, Police and Security Service as
soon as possible.
".,

7. PROFICIENCY REPORTS:

All officers will maintain proficiency in the use of the issued firearms in accordance with the
trainiflglIrandards of the Office of Security and Law Enforcement: Records will be
maintained by the designated firearms instructor or armorer. All officers failing to meet the
minimum proficiency level will undergo remedial training. If after remedial training, the
officer is unable to meet the Agency's minimum proficiency level, the firearms instructor will
notify tlie Chief, Police and Security Service in \vriting. Thc effected officer will be
prohibited from carrying the is.'iiied firearm until slIch tinle as the officer is able to qualify
with the Iircartl1.
 302

8. INSPECTION OF DUTY GEAR AND ISSUED WEAPONS:

The Chief, Police and Security Services or a designated representative may inspect the issued
duty belt, related equipment, and firearm without notice. Any item found to be unsafe,
unserviceable, worn, or broken will be replaced as soon as possible. All unauthorized
equipment is prohibited and the officer will be subjcct to disciplinary action.

9. LOADING AND UNLOADING PROCEDURE AREAS:

The Chief, Police and Security Services will designate an area for officers to load and unload
firearms. It is recommended that this area will be out of public or hospital staff view. This
area will be equipped with a large metal container (fifty five gallon drum) filled at least three
quarters full of loose sand type materia.l. The metal container will be mounted on a frame that
maintains an approximate forty five dcgree angle. The container will have an approximate
four inch by four inch opening at one end to place the muzzle into the opening. There must be
a minimum of twelve inches of thickness of the sand type material inside the container.

The officer will receive the issued firearm with the slide locked to the rear and the magazine
out. The officer will visually inspect all the issued magazines for damage and if the magazines
are loaded to capacity. The officer will then proceed to the loading I unloading area
maintaining the strong index finger outside of the trigger guard and off the trigger. The
officer will then place the muzzle into the opening on the barrel, insert a loaded magazine into
the magazine well, check to make sure the magazine is'seated and locked into place. The
office will then activate the slide stop, allowing the slide to u.veI forward chambering a live
cartridge. The officer will then holster and secure the firearm and all holster securing devices.
TIle firearm is now considered to be loaded and ready for duty use. The officer would then
complete the weapons log. .

The officer will return the issued firearm to the issuing officer or designated person by the
Chief, Police and Security Services at the completion of their tour of duty. The officer will
proceed to the loading I unloading area. The officer will then remove the magazine from the
firearm while it is still secured in the holster. The officer will utilize the strong hand thumb,
placing the thumb between the duty belt and lower frame of the firearm . The officer will then
activate the magazine release. The officer will then extract the magazine from the firearm
utilizing the strong hand. The officer will then place the extracted mag87jne from the firearm
into a trouser or coat pocket. llte officer will then extract the firearm from the holster,
maintaining the strong index finger outside of the trigger guard and off the trigger, place the
muzzle of tile firearm into the barrel opening. then pull the slide to the rear. extracting the live
cartridge from the firing chamber. TIle officer should not attempt to catch the extracted
cartridge from the firing chamber but allow it to fall freely. The officer should then retract the
slide a minimum ofthrce times,lock the slide back to the I'CjIr and then make a visual
inspccti~n to insure no live cartridges arc in the firing chamber. TIle officer should receive
the firearm with the slide locked back to the rear with an empty magazine well . The officer
would then retunt all issucd magazines "",I ammunition and complete the weapons log.
 303

10. ARMED RESPONSE TO LOCKED WARDS:

If the situation dictates the officer to respond to a locked ward, certain considerations must be
undertaken. The officer will be required to disann the fireann prior to entering any locked
ward. The officer will remove the magazine and live ~dges from the issued weapon. .This
is accomplished by placing the strong hqdthumb between the duty belt and lower frame of
the fireann. The officer then activates the magazine release. The officer will then remove the
magazine from the magazine well with the strong hand. The extracted magazine is then
placed into a trouser or jacket pocket. The officer will then inspect and insure that all holster
safety features are engaged and secured. The firearm is not removed from the holster during
this entire process. The live cartridge in the firing chamber is inca.-.ble of being fired while
the rnag~ne is out of the magazine well .

II. UNINTENTIONAL AND ACCIDENTAL DISCHARGES:

In the event that the officer experiences anyunintentional or accidental discharge of a firearm
resulting in property damage, serious physical injury or death of an individual; the effected
officer will immediately notify their immediate superviSor. The supervisor will then notify
the Director of the facility and notify the Office of Security and Law Enforcement. The Chief,
Police and Security Services will also initiate an investigation into the mitigating
circumstances surrounding this event. Copies of this investigative report will be faxed to the
Office of Security and Law Enforoement and a courtesy copy faxed to the Law Enforcement
Training Center as soon as feasible.

12. INTENI10NAL DISCHARGING OF FIREARM I QFFICERINYOL\1ED

SHOOTING:

In the event that the officer experiences any intentional discharge of a fireann resulting in the
serious physical injury or death of an individual, the effected officer will immediately notify
their il1UlleCiiate supervisor. The supervisor will then notify the Chief, Police and Security
Services. The Chief, Police and Security Services will notify the Director of the facility and
notiiY the Office of Security and Law Enforcement and other appropriate Law EnfOl:cement
agencies. The Chief, Police and Security Services will initiate an investigation into the
mitigating circum~tances surrounding this event. Copies of this investigative file will be
faxed to the Office of Security and Law Enforcement and a courtesy copy fa,,~ to the Law
Enforcement Training Center as soon as rca~ible .

The responding Officer to an Oflicer Invnl\'cd Shooting will:

a. Stabili7.c and secure the scenc.

b. Check on the well being orthe oflicer and people Ioc.,ted at the scene.
c. Call for medical assistance a~ needcd .
d. Notify the on duty Supervisors and request adequatc assistancc .

:111
The respon~ing Supervisor will:

a. Insure that the Chief, Police and Security Services is notified.

b. Insure that the Director of thC facility is notified.
c. Insure that the appropriate outside Law Enforcement agencies are notified.
d. Insure that the Crime Scene is secured and protected.
e. Secure the Officer's firearm by taking custody as expeditiously as possible.

I. THIS WILL NOT BE PONE IN PUBYC VIEW

2. The firearm will be handled as evidence.
3. The officer will be issued another firearm as soon as practical.

The involved Officer win be removed from the scene as soon as practical:

a. De omw willican Che scene jnChe FRONT sut of. Police unjt,
b. The officer should not be left alone, another officer or a person of the officer's
choosing should stay with them until the officer is home with a family member or friend.

The Chief, Police and Security Services will insure that the investigation of the event will be
completed in.a timely fashion and keep the Director of the Facility and the Office of Security
and Law Enforcement abreast of the on going investigation.

The officer that is involved in the shooting incident must realize that they are subject to the
same investigative procedures as WOUld apply to any other criminal investigation, including
the application of the Miranda Warnings.

The responding offIcerS and supervisors arriving at a shooting scene should determine from
the involved officer that a shooting incident took place, if theofficer is injured, and if there
are any other persons involved in the incident, Descriptions or the identity of other persons
involved should be obtained. The on site supervisor will ensure that the involved officer is
not questioned about the incident until a supervisor of the investigations division arrives and
assumes control of tile investigation.

Investigators will conduct the investigation in a fair and impartial manner, as in any other
criminal investigation. The involved officer will be informed oCthe Miranda Warnings and
asked to assist investigators in reconstructing the incident.
 305

DEI'ARTMENT OF VETERAN'S AFFAIRS POLICE DEPARTMRNT

flllU':AltMs ARMOREWS REI'ORT
REl'OItT II~_ _ _ __

nATE: _ _ _ _ __

WEAPON: _ _ _ _ __

SElUAL NUMBER: _ _ _ __

V.A.P.D. NUMBER: _ _ _ __

_ _ _ _ _ _ DETAIL CLEANING (ANNUAL)

_ _ _ _ _ _ MALFUNCTION TYrlt_ _ _ _ _ _ _ _ _ _ _ __

_ _ _ _ _ _ INSPECTION

_ _ _ _ _ _ DAMAGR

DESCIUBE TYPE OF MALFUNCTION I IlAMAGE

DESCRIBE REPAIR ACTION TAKEN OR CLEANING RESULTS

INSPECTION RESULTS:

_ _ WEAPON CLEAN (OPERATOlt MAINTENANCE SATISFACTORy)

_ _ WEAPON DIRTY (OPERATOR MAINTENANCE UNACCEPTABLE)
MECHANICAL I)EFECTS OR AIlNORMAL WEAR NOTED
NO MECHANICAL UJ<:flECTS OR AIlNORMAL WEAR NOTED

nATI~ ItETUltNlm TO OFFICF.lt:

1'lImAI{MS I NSTIHJCTOI{ I AltMOI{FU:

.J'
 306

.n~ TO QUlSTIOII '8

C.-pbe.l1Letter

U.S. Department of Justice

Federal Bureau of Investigation

FBI Academy
Quantico, Virginia 22135

April 29, 1996

Mr. Ronald R. Angel, Director

VA Law Enforcement Training Center (07A/NLR)
2200 Fort Roots Drive
North Little Rock, Arkansas 72114
RE: Department of Veterans Affairs' (VA) letter,
dated February 28, 1996, to
Section Chief John H. Campbell
FBI Academy, Quantico, Virginia,
and subsequent meeting with Director Ron Angel,
VA Law Enforcement Training center
Dear Director Angel:
As reflected in discussions regarding the request to
review the VA Police Officer Basis Training Course, the FBI
Academy is not specifically or directly involved in basic law
enforcement training. However, a review was conducted of the
recommended training program to determine relevancy as a course
for preparation ot basic VA police. This course of training was
compared to similar curriculum design not only for the Basic
Officers Training provided at the Federal Law Enforcement
Traininq Center in Glynco, Georgia., but that provided by several
state academies. The proposed 160~hour course appears to be
consistent with 'the standards established by the aforementioned
traininq courses. The curriculum design is appropriate and the
reference materials, both books and documents,are consistent
with those reterence materials utilized in Basic Officers
Training.
It is further noted. that the Criminal Justice
Department at the-University of Arkansas at Little Rock has also
reviewed and recognized this basic training course and provided
college accreditation for its successful completion.
This review was conducted within the parameters and
scope requested by you, and, in conclusion, the Basic 1raining
Course for VA police officers appears to be relevant and
 307

Mr. Ronald R. Angel

consistent with basic law enforcement training; however, the FBI

Academy at Quantico, Virginia, does not certify nor accredit the
basic law enforcement " training course. The FBI is pleased to
assist the VA in this matter. If further assistance is deemed
necessary, please contact me at 703-640-1103.

Sincerely,

J09'::!b.~fkl(
section Chief

2
 308

ATTACHMENT TO QUESTION 18
Jacuon Letter

u.s. Department of Just;

Fcdual Bureau of Inva tigatioo

FBI Academy
Ia Reply. PIca.e ltefc.r 10 Quantico, Virginia 22135
.,-ok No. 0271-26 Sub A
June 11, 1996

Mr. Scott Charny

Acting Chief, General Litigation
and Legal Advi~e section
criminal Division
u.s. Department of Justice
10th and Constitution Avenue, Northwest
Washington, D.C. 20530
Dear Mr . charny :
The purpose of this letter is to bring closure to an
issue that has delayed the iaplementation of a Department of
Veterans Affairs (OVA) firearms training program which requires
approval by the Department of Justice (DOJ).
The FBI Academy was asked to rev-i ew a curriculua
proposed by the DVA which would allow that agency to have an
autonomous firearms training program. This proposal had the full
support of the Secretary of the OVA but required the imprimatur
of the DOJ.
1 - Mr. Jeff Fogle
Department of Justice
lOth and constitution Avenue, Northwest
Washington, D.C. 20530
I - Mr. Harold Gracey
Chief of Staff (OOA)
Department of Veterans Affairs
810 Veraont Avenue, Northwest
Washington, D.C. 20420
I - Mr . William Harper
Director, Police and Security services
Department of Veterans Affairs
810 Veraont Avenue, Northwest
Washington, D.C. 20420
 309

Letter to Hr . scott Charny

I was initiali.y contacted byMr. Jeff ' Fogel of your

staff who asked for my opinion of the adequacy of the OVA
proposal. I exPressed to Mr. Fogel that, based upon 1nformation'
that was available at. the time, the . ~BI' ,c o\l.ld not and would not
comment upon or endorse the OVA proposal. Since that time,
however, the OVA has provided both me and FBI Academy Academic
section Chief John Campbell, Phq., with voluminous information .
about their proposed training proqram, includinq specific course
content, lesson plans, courses of fire, and qualification
requirements. It':Wa,s .. bo~ , my opinion and that of Dr. campbell
that the proposal was (1) adequate for its intended purpose' and
(2) consistent with similar programs in the . f~d~ral law . .
enforcement community. ' This 'opinion' was formally: 'eXpressed to
Mr. Ron Angel, Director of OVA Training operations, and Mr. ,
William Harper, Director of OVA Police and Secur,ity Services Who
subsequently provided the information to Mr. Fogel.. .
Mr. Fogel reportedly requested additional information
regarding the comparability of the OVA firearms (as opposed to
'purely academic) program to similar proqrams taught at the
Federal I.aw Enforcement Training Center (FLETC), Glynco, Georgia,
before approving the OVA training proposal.
I recently visited FLETC and personally discussed the
DVA proposal with FLETC's Chief Firearms Instructor, an
individual tasked with oversight of the firearms trai~ing
programs of FLETC's 76 tenant agencies. Based upon this
conversation, I can unequivocally state that the course content
and qualification requirements of the OVA proposal exceed or are
equivalent to the qeneric training 'offered by the FLETC staff and
the firearms related training programs of most federal agencies,
with the exception of the Federal Bureau of Investigation and the
Drug Enforcement Administration.
I hope this will satisfy the DOJ's requirements for
approval of the DVA proposal. If I can be of further assistance,
please contact me @ (703) 640-1185 or by fax @ (703) '640-1'498.
Sincerely Yours,

~JaCkSOn,
~~f~~~f Jr.
Firearms Training unit

2
 310

ATTACHMBMT TO QUBSTIOI1 'lOB

Departa.t erv.cenu Affaln VBA HANDBOOK 11 .1

v..... B ..... Ad8iJUItntio. (Date)
W......... OC2N18 Tnullliaal SIleet
INSPECI'ION or CONTROLLED SUBSTANC1'3

I . RJ:A.SON rOR ISSUE: 1bia Vetenos He8lth Administration (VHA) Handbook provides
proccdun:s for impIcmaIIinc COlltrolIed SubsImcc Inspection Program.

2. SUMMARY or MAJOR CHANGES: 1bia VHA HaudbooIr. iuI:orponIcs requiremeIIII

RpdiIIc !be impJcmcnPtioD of. CoaIroDed S1JbstImce IDspcdioo PropIm. aDd !be
~1IiIitieI tbaeto.

3. RELATED DIIlECTIVE: None.

4. RESPONSIBLE OrrICK: The Chief CoasuItmt, PJ.rma&:y Beudits Maaaacmcat S1ratqic

Heahh Gaoup (119) is respoasible for tho IlOIItcntB of this Hmdboot.

~. RJ:SCISSIONS: This VHA Hadbook n:acinds VHA MuuaI M-2, P_I, CIIIIpIer 2.

6. RJ:CEIlTD'ICATlON: The cIoc:un.rt is sbDduIed for recertificaIion aoIat bd'OR the Iul
-me day of (maaIb) 2002.

K.....- W. KizIr. M.D.. M.P.H.

UJMIcr SecnUIy fiIr HeaIdt

DiIcri. .: 1tPC:
PO
I..,. .........

T-I
 311

'(Date) VHA HANDBOOK 1108.1

CONTENTS

INSPECflON OF CONTROLLED SUBSTANCES

PARAGRM'H PAGE

1. Purpose.... .. ..... ....... .... .... .... .... ....... ....... .... ..... ...... ..... ........ ............... .... ........ ........ ... ....... ..... ........ 1

2. Definition and Authority ....... ... ....... ..... ... .... ........ ............ ....... .... .... ............ .... ...... ..... ....... ......... 1

3. Scope ......................................................................................................................................... 1

4. Responsibilities of Medical Facility Director ........................................................................... 1

S. Responsibilities of Chief, Pbarmacy Service ............................................................................ 2

6. Responsibilities oflnspecting Official ....................................................................................... 2

7. Physical Inventory of Pharmacy ............................................................................................... 2

8. Physical Inventory of Nursing Units and Storage Areas .......................................................... 3

9. Physical Inventory of Automated dispensing Equipment on Nursing Units and in

Storage Areas ......................................................................................................................... 3

10. Procedure in Case of Discrepancy or Loss of Controlled Substances .................................... 4

 312

(Dat.) VHA HANDBOOK 1108.2

INSPEcrION OF CONTROLLED SUBSTANCES

1. PURPOSE

It is Department of VetenIIIs Affain (VA) policy that a Controlled Substance Inspection

Program be implemented III all VA medical facilities aDd clinics. This HaruIbook.provides the
direction to implement this policy.

1. DErJNITION AND AUTHORITY

Controlled substances subject to inspection consist of drugs aDd other substences

by whatever offICial name, common, or usua\ name, chemical name, or brand name designated,
that are listed in Title 21 Code of Federal Regulations (CFR) Schedule 111308.12, Schedules 1II
1308.13, Schedule IV 1308.14, and Schedule V 1308.15

3. SCOPE

Areas to be iospectedare pharmacy, wards, clinics, laboratories, and all other areas having
ScbaIule II to V controlled substances.

4. RESPONSIBILITIES OF MEDICAL FACILITY DIRI:CfOR

Directors of VA medical facilities, domiciliaries, outpatient clinics, and regional offices with
outpatieot clinics are responsiblo for estah\isbinl an IIdequate aDd coll1pRheosive system for
controlIed substances to ensure safety aDd control of stocb.

a. The Directors of VA medical facilities, domiciliaries, outpatient clinics, and regional

offices with outpatient clinics are to establish a local written medical facility policy on the use
aDd inspection of controlled substances. There will be a monthly !!I!8!!DOIlIICe controlled
substance inspection. The inspections will randomly survey all wards aDd storage areas to ensure
the element of surprise . .The Inspectors will physically count and certify the accuracy of
controlled substances III each site inspected. No inspector will inspect the same area 2 months
consecutively

b .The Director III each facility is responsible for reacquainting the staff with all current VA
directives, including those relatina to physical security. The facility DireCtor, or designee, must
maintain written records of all inspections. The Director, or designee, is to trend inspection
resu1ts to identify poteDtia\ problem areas for improvement.

c. The facility Director must ensure that a proaram for orientlUion and training of inspecting
officials is established and followed. Each medical facility must msintain documentation on all
orientlUion and training provided.

d. The facility Director appoints, in writing, one or more disinterested person(s) (who will not
be pharmacists, nUl'lClll, physiciaDs, or supply officials), as controlled substance inspectors.
 313

VHA HANDBOOK 1108.1 (Date)

e. The medical facility Dim:tor appoints an adequate number of inspectors to meet the needs
of the facility. There is to be a rotation of inspectors to ensure that 1\0 single inspector will
conduct more than six monthly iDspcctions in a 12 month period. A portion of the inspectors
rotates out of the inspection team each year.

s. RESPONSIBILITIES OF CmEF, PHARMACY SERVICE

a The Chief, Phannacy Service, or designee, will submit monthly to the appointed
responsible inspecting official(s), a complete list by wards and clinics of the serial and sheet
number of VA Form 10-2638, Controlled Substance Adminilttation Record. This list will
provide all serial numbers that are available on the Nursing Units and storage areas to be
inspected. The inspecting official uses this list in the monthly check of wards' and clinics'
controlled substance stocks and records to confirm that all records and stocks are available for
inspection. The inspecting official will have access to the inactive VA Form 10-2638, or
electronic equivalent returned to "the pharmacy since the last inspection. Facilities utilizing
automatic replenishment will provide records for controlled substances as requested. The records
used in monthly inspection may be part of the Decentralized Hospital Computer Program
(DHCP) system or automated controlled access dispensing equipment.

b. The Chief, Phannacy Service, and Chief, Acquisition and Materiel Management (A&MM)
Service, will keep current copies of21 CFR, Part 1300 to end in their office and in the master
controlled substance storage location.

6. RESPONSIBILITIES OF THE INSPECTING OFFICIAL

The inspecting official certifies by memorandum to the facility Director, the 8CCUl'llCy of the
records and inventory of the controlled substances that have been inspected. Wards and clinics
will be specified. The lists used by the inspecting officials in conducting the inspection are to be
returned promptly to the phannacy.

7. PHYSICAL INVENTORY OF PHARMACY

The Chief, Phannacy Service, or designee, is present during the monthly inventory and
inspection. The physical inventory and inspection includes all stock of Schedule II to V
controlled substances, outdated stock, and records (VA Forms 10-2320, Schedule II, Schedule lIT
Narwtics and Alcohol Register, 10-2638, 10-2477 F, Security PrescriptionForm, and electronic
equivalents).

a. The inspecting official(s) certifies the accuracy oCthe records by dating and signing VA
Form 10-2320, or electronic equivalent for each drug or preparation at the time of inspection
after completing the following actions:

(I) The inspector physically COlDlts and reconciles each controlled substance for accuracy and
completeness. The inspector weighs all unsealed powders and measlU'C all liquids with a

2
 314

(Date) VBA HANDBOOK 1108.2

volumetric cylinder. NOTE: The inspecting oJlWial should not open any sealed packages of
comol/cd substancc for tICtIIaI 00l11li unJus thue appeOTS to be evidence oftampering.

(2) The inspecting official reviews receiving reports by comparing entries on the voucher
copies furnished to them by A&MMService. or Prime Vender Receiving reports, against all
entries of quantities received on VA Form 10-2320 in the pharmacy. The calculations (quantity
received plus previous balance minus quantity dispensed equals present ba1ance) will be checked
for accuracy for each drug Dr preparation during each inspection.

NOTE: To verify the QCcuracy ofvault brvenrory records the inspectors should randomly verify
the infonnotion from the fallowing documents which support the dispensing activities in the
master inventory: Prescriptions. Active VA Form 10-2638 (or electronic equivalent). Inactive
Form 10-1638.

b. All excess, outdated, unusable, returned controlled substailces must be inspected monthly
and destroyed at least quarterly. The inspecting official ensures any drug stock removed from
inventory for destruction since the last inspection, ill properly logged into the record of drugs
awaiting destruction.

8. PHYSICAL INVENTORY OF THE NURSING UNITS AND STORAGE AREAS.

a. The head DIIISC, nlllSC manager, or, in their absence, the nurse in charge of the clinic or
ward inspected is to be JRSCIlt during the inventory and inspection of controlled substances.

b. An actual physical count of controlled substances OD hand will be taken and reconciled for
accuracy and completeness. The calculations (quantity received plus previous balance minus
quantity dispensed equals present balance) will be accomplished -and proved for each drug or
preparation during eachinspection.

c. To verify entries the inspectors will compare a sample of ward dispensing entries to patient
records to verify that anwunts removed from clinic or ward inventories were
supported by
doctors' medication orders and drug administration records in the patients' charts. The
inspectors will compare a sample of any transfers from one Controlled substance area to another.

d. The Inspector will sign and date VA Form 10-2638 (or electronic equivalent) Dr enter
signatuJc in DHCP verifying KC\IJ'8Cy of records on the nursing unit Dr other storage area.

9. PHYSICAL INVENTORY OF AUTOMATED DISPENSING EQUIPMENT ON

NURSING UNITS AND OTHER STORAGE AREAS.

Where medical facilities use automated dispensing equipment for controlled substances
(i.e., Access, SureMed, Pyxis, Meditrol and others), these should be linked to DHCP for
Admission, Discharge, and Transfer (ADn information.

a. The medical CCDter must have specific written instructiDIIS for the inspectors on how to
inspect each automated dispensing device.

3
 815

VHA HANDBOOK 1108.1 (Date)

b. Eachinsptdor is assigned a temporary access code for the automated dispensing equipment
for the period covering the inspection only.

c. An actual physical count of controlled substances on hand will be taken and reconciled for
accuracy and completeness. The calculations (quantity received plus previous balance minus
quantity dispensed equals present balance) arc to be accomplished for each drug or preparation
during each inspection. Audit reports are to be run from both DHCP and the automated
dispensing equipment and reconciled against the physical inventory.

NOTE: To verify entries the inspectors should compare a sample ofward dispensing entries
logged In the automated dispensing equipment to patient records to v!,rify that amounts removed
/rom automated dispensing equipment on the clinic or wards were supported by doctors'
medication orders and drug administration records In the patients' charts.

d. The Inspector will sign and date VA Form 10-2638 or electronic equivalent in the
automated dispensing equipment or enter signature in DHCP verifYing accuracy of records in the
automated dispensing equipment according to local written policy.

10. PROCEDURE IN CASE OF DISCREPANCY OR LOSS OF CONTROLLED

SUBSTANCES

a. In cases of inaccuracy in balance of records, the inspecting official(s) will report the
discrepancy to the accountable official (e.g., Chief, Pharmacy Service, Head Nurse) who will
determine the cause to the satisfaction of the inspecting official(s);and make a report of findings
to the facility Director, who will take appropriate action.

b. In the case of accidental loss, suspected theft, diversion, or suspicious loss, the procedures
outline in VHA Handbook 1108.1, paragraph 8, will be followed.
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.....
 317

Congressman Snyder to Charles F. Rinkevich, Director, FederAl

Law Enforcement Training Center, Department of Treasury

QUESTIONS SUBMITIED BY THE HONORABbE VIC SNYDER

1. Your statement refers to great projected savings from all training being done at FLETC
because of an estimated per diem rate of $152 per day. Iso' t that an inaccurate method of
analysis since the VA security police trainees get no per diem, and the VA houses them
on the VA hospital grounds in North Little Rock at VA expense?

Answer:

The FLETC currently conducts training for 70 Federal law enforcement agencies,
including the V A's Office of the Inspector General. The statement on projected savings
is based on the workload projections provided by the 70 participating agencies and is a
comparison of the General Service Administration' s per diem rate in major cities as
opposed to the meals and lodging cost at FLETC. In this context, it is a very accurate
calculation of the savings. For the VA, a more accurate comparison would be the cost of
meals and lodging at North Little Rock vice those at FLETC. The per day costs at
FLETC are: $10.73 for meals; $9.53 for lodging; and $5.00 for miscellaneous per diem
(this item is discretionary and may or may not be paid pending the decision of the bureau
head). Since FLETC does not know the costs incurred by the VA to house and feed
trainees in North Little Rock, a comparison cannot be provided. The VA can probably
provide the costs at North Little Rock.

2. When an agency contracts with you to provide training to their trainees, please describe
the length of basic training, and the cost to the agency. Please include any travel
expenses so I will know the total cost to the agency both per week and for the total
duration of the training.

Answer:

Federal agencies do not "contract" with FLETC for training. Essentially, the FLETC is a
voluntary association with each agency' s participation governed by a Memorandum of
Understanding. When an agency becomes a participating member; i.e., signs a
Memorandum of Understanding, the FLETC and the Treasury Department provide the
facilities (dannitory, cafeteria, classrooms, and specialized facilities far physical, driver,
fireanns, and computer training) and equipment required to conduct the training. The
FLETCffreasury/Oflice of Management and Budget funding policy is that the FLETC
also funds the direct cost of basic training. The participating agencies are responsible for
their respective student costs of travel and en route per diem, and reimburse the FLETC
for meals and lodging. The direct costs afbasic training include items such as: -utilities
for the classrooms, printed text material, rgle players, support contract services,
ammunition, and materials/supplies used in the conduct of training. The FLETC offers
several basic training programs, each with different lengths. The VA wo}lld attend the 8-
week Mixed Police Basic Training Program and the students are in residence for 61 days.
The current costs are:

Meals $654.53
Lodging 581.33
Tuition 1,016.29
Miscellaneous ~
Total $2,867.03

Per the funding agreement, the participating agencies reimburse the FLETC for the Ii",t
two items (meals and lodging amounting to $1,235.86) and the FLETC funds the last two
(tuition and miscellaneous amounting to S1,631 .17). The weekly cost to the agencies
attending this program would be approximately $166 and the total cost is $1,236
(rounded).

The agencies are also responsible for student travel. Since the FLETC is not involved in
the travel, an estimate of diOse costs cannot 'be provided.

o
 ISBN 0-16-055999-5

9 801